Variability in the time to initiation of CPR in continuously monitored pediatric ICUs

Olson, Michelle; Helfenbein, Eric; Su, Lillian; Berg, Marc D.; Knight, Lynda; Troy, Lindsey; Sacks, Loren D.; Sakai, Debbie S; Su, Fang

doi:10.1016/j.resuscitation.2018.03.033

Cited by 5 publications

(7 citation statements)

References 30 publications

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“…Gradual pulseless arrests deteriorated over several minutes with substantial declines in PP. This group was the largest in our cohort, possibly because it was the most common cause of arrest in surgical cardiac patients, which were a larger subset of our cohort compared with similar studies (2,7,34,37,38). We hypothesize that poor cardiac function with low baseline MAPs and diastolic pressures may make these patients vulnerable to decreases in coronary perfusion pressure leading to IHCA.…”

Section: Discussionmentioning

confidence: 89%

“…However, there are no criteria for detecting IHCA based on patients’ objective monitored data. Several studies have suggested methods for recognizing deterioration in monitored patients based on combinations of ECG, ABP waveform, pulse oximetry, and end-tidal CO 2 , but none have been prospectively validated ( 28 , 33 , 34 ). We believe, based on our findings, that monitoring changes in an expanded range of derived physiologic variables, including proxies for CO, SV, and SVR, may permit more proactive recognition of deterioration and possibly earlier CPR initiation.…”

Section: Discussionmentioning

confidence: 99%

“…First, research shows that clinician-reported IHCA times are inaccurate, often due to delays in documentation, inaccurate recollection, and poor synchrony between the clocks used for documentation ( 30 – 32 ). Second, studies have shown that patients often deteriorate prior to the reported IHCA times ( 33 , 34 ). Third, AWAO is an objective, patient-based definition that can be directly determined form arterial waveforms.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Hemodynamic Patterns Before Inhospital Cardiac Arrest in Critically Ill Children: An Exploratory Study

Erez

Mazwi

Márquez

et al. 2021

Critical Care Explorations

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic Patterns Before Inhospital Cardiac Arrest in Critically Ill Children: An Exploratory Study

Erez

Mazwi

Márquez

et al. 2021

Critical Care Explorations

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show abstract

“…Electrocardiography, blood pressure, end-tidal carbon dioxide (EtCO 2 ), respiratory rate, and plethysmography continuous waveforms were used to extract CC data from the surgical start of ECMO cannulation, the documented surgical start time in our surgical records, to the onset of ECMO circuit flow. CC was identified by the onset of cyclic artifacts in the continuous waveforms as done in previous publications (36, 37). Patients whose leads were removed during CPR were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation

Han,

Rasmussen,

et al. 2024

Pediatric Critical Care Medicine

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Objectives: To determine the association between chest compression interruption (CCI) patterns and outcomes in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Design: Cardiopulmonary resuscitation (CPR) data were collected using defibrillator-electrode and bedside monitor waveforms from pediatric ECPR cases between 2013 and 2021. Duration and variability of CCI during cannulation for ECPR was determined and compared with survival to discharge using Fishers exact test and logistic regressions with cluster-robust ses for adjusted analyses. Setting: Quaternary care children’s hospital. Patients: Pediatric patients undergoing ECPR. Interventions: None. Measurements and Main Results: Of 41 ECPR events, median age was 0.7 years (Q1, Q3: 0.1, 5.4), 37% (15/41) survived to hospital discharge with 73% (11/15) of survivors having a favorable neurologic outcome. Median duration of CPR from start of ECPR cannulation procedure to initiation of extracorporeal membrane oxygenation (ECMO) flow was 21 minutes (18, 30). Median duration of no-flow times associated with CCI during ECMO cannulation was 11 seconds (5, 28). Following planned adjustment for known confounders, survival to discharge was inversely associated with maximum duration of CCI (odds ratio [OR] 0.91 [0.86–0.95], p = 0.04) as well as the variability in the CCI duration (OR 0.96 [0.93–0.99], p = 0.04). Cases with both above-average CCI duration and higher CCI variability (sd> 30 s) were associated with lowest survival (12% vs. 54%, p = 0.009). Interaction modeling suggests that lower variability in CCI is associated with improved survival, especially in cases where average CCI durations are higher. Conclusions: Shorter duration of CCI and lower variability in CCI during cannulation for ECPR were associated with survival following refractory pediatric cardiac arrest.

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“…In 1 study, children with an arrest rhythm of PEA experienced a significant delay from onset of CPA to start of CPR compared to infants with ECG diagnoses of either bradycardia or ventricular fibrillation. 171,172 In experimental studies in dogs subjected to uncoupling of electrical and mechanical heart function and pigs subjected to asphyxial arrest, the ECG indicated either no change or bradyarrhythmias for a period of time (4-6 min) without a perfusing rhythm, highlighting the major problem with sole reliance on ECG monitoring to diagnose CPA in certain scenarios. 173,174 In a study of pediatric CPA, other monitored parameters such as blood pressure and pulse oximetry more accurately diagnosed CPA than the ECG.…”

Section: Consensus On Sciencementioning

confidence: 99%

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

Brainard,

Lane,

Burkitt‐Creedon

et al. 2024

J Vet Emergen Crit Care

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ObjectiveTo systematically review evidence on and devise treatment recommendations for patient monitoring before, during, and following CPR in dogs and cats, and to identify critical knowledge gaps.DesignStandardized, systematic evaluation of literature pertinent to peri‐CPR monitoring following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by Monitoring Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.SettingTransdisciplinary, international collaboration in university, specialty, and emergency practice.ResultsThirteen questions pertaining to hemodynamic, respiratory, and metabolic monitoring practices for identification of cardiopulmonary arrest, quality of CPR, and postcardiac arrest care were examined, and 24 treatment recommendations were formulated. Of these, 5 recommendations pertained to aspects of end‐tidal CO2 (ETco2) measurement. The recommendations were founded predominantly on very low quality of evidence, with some based on expert opinion.ConclusionsThe Monitoring Domain authors continue to support initiation of chest compressions without pulse palpation. We recommend multimodal monitoring of patients at risk of cardiopulmonary arrest, at risk of re‐arrest, or under general anesthesia. This report highlights the utility of ETco2 monitoring to verify correct intubation, identify return of spontaneous circulation, evaluate quality of CPR, and guide basic life support measures. Treatment recommendations further suggest intra‐arrest evaluation of electrolytes (ie, potassium and calcium), as these may inform outcome‐relevant interventions.

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Variability in the time to initiation of CPR in continuously monitored pediatric ICUs

Cited by 5 publications

References 30 publications

Hemodynamic Patterns Before Inhospital Cardiac Arrest in Critically Ill Children: An Exploratory Study

Hemodynamic Patterns Before Inhospital Cardiac Arrest in Critically Ill Children: An Exploratory Study

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation

2024 RECOVER Guidelines: Monitoring. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR

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