Extracorporeal cardiopulmonary resuscitation (EC-CPR) for hypothermic arrest in children: Is meaningful survival a reasonable expectation?

“…None of the studies were multi-site, and they all occurred prior to the publication of the Pediatric Emergency Medicine Practice clinical pathway. Other studies were identified but included other means of obtaining hypothermia (i.e., avalanche and cold weather), and the submersion injury sample within the larger sample was not parsed out for separate analysis, so those studies are not reported here [ 14 , 15 , 16 ]. The reviewed studies showed that a resuscitation time <30 min, early CPR, the female gender, bradycardia, and slow rewarming speed were associated with improved outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Five retrospective, single center studies were identified. Other studies were identified, but hypothermia samples were not related to cold water submersion (i.e., avalanche victims), or the cold water submersion sample within the larger sample was not parsed out for separate analysis, so they are not reported here [ 14 , 15 , 16 ]. Patient information was obtained via retrospective chart review.…”

Section: Methodsmentioning

confidence: 99%

Pediatric Hypothermic Submersion Injury and Protective Factors Associated with Optimal Outcome: A Case Report and Literature Review

et al. 2017

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Drowning is the 3rd leading cause of unintentional injury death worldwide, with the highest rates of fatality among young children. Submersion injuries with cardiac arrest can lead to long-term neurologic morbidity. Severe hypothermic submersion injuries have complex treatment courses and survivors have variable neurocognitive outcomes. We describe the course of a hypothermic submersion injury in a 6-year-old previously healthy boy. The description includes premorbid and post-injury neurocognitive functioning. A review of the literature of pediatric cold-water submersion injury was performed. Despite prolonged cardiopulmonary resuscitation (>100 min) and water temperature well above freezing, our patient had an optimal neurocognitive outcome following hypothermic submersion injury. Available literature is limited but suggests that increased submersion time, increased duration of resuscitation, and higher water temperatures are associated with worse outcomes. Care guidelines have been created, but outcomes related to these guidelines have not been studied. Our case highlights potential important determinants of outcome after drowning. Incident specific characteristics and therapeutic interventions should be considered when evaluating this population. Treatment guidelines based on currently available literature may fail to incorporate all potential variables, and consideration should be given to prolonged resuscitative efforts based on individual case characteristics until further data is available.

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“…3 Some survivors of coldwater drowning and avalanche suffocations with hypothermic arrest may experience neurologic recovery. 4 Recent advances in whole body temperature-controlled perfusion allowed for full neurological recovery after 10 minutes of prolonged asystole with hypothermia. 5 Rare cases of “recovery after neurologic death” may further obfuscate both clinician and layperson understanding of the reversibility of brain death.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning with Objective Serum Markers and Algorithmic Deep Learning CT Scan Analysis Predicts Brain Death Due to Trauma and Hypoxia

Rafter

Sterk

et al. 2021

Preprint

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Objective: Brain death is a controversial construct because proving irreversible cessation of neurologic function is difficult, and ascertaining the timepoint at which irreversibility has occurred is not currently possible. The ability to predict which traumatic (TBI) and hypoxic brain injuries will progress to brain death is also limited. We investigated how accurately neurologic serum markers can predict brain death and differentiate its etiology. Methods: This prospective observational study enrolled brain injury subjects presenting to a trauma center within 32 hours of injury. Levels of glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and S100 Calcium-Binding Protein B (S100B) were compared. Clinically brain dead (BD) subjects were further subdivided into high velocity trauma with presumed diffuse axonal injury (DAI), cardiopulmonary/respiratory arrest (CA/RA), and found down (FD). Results: The prognostic value of various biomarker combinations in identifying subjects progressing to brain death was assessed using machine learning. Prediction accuracy for GFAP, UCH-L1, and S100B in combination to predict brain death from among all other cohorts yielded an area under the curve (AUC) of 0.98 versus all other brain injury subjects. This model was also able to distinguish CA/RA BD from combined non-trauma controls and DAI BD with an AUC of 0.99. Conclusion: Serum concentrations of GFAP, UCH-L1, and S100B measured within 32 hours of traumatic and hypoxic brain injury have utility in prognosticating brain death by mechanism of injury as either hypoxic (CA/RA) or traumatic/unknown (DAI and FD).

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Extracorporeal cardiopulmonary resuscitation (EC-CPR) for hypothermic arrest in children: Is meaningful survival a reasonable expectation?

Cited by 28 publications

References 8 publications

Extracorporeal-Assisted Rewarming in the Management of Accidental Deep Hypothermic Cardiac Arrest

Extracorporeal-Assisted Rewarming in the Management of Accidental Deep Hypothermic Cardiac Arrest

Pediatric Hypothermic Submersion Injury and Protective Factors Associated with Optimal Outcome: A Case Report and Literature Review

Machine Learning with Objective Serum Markers and Algorithmic Deep Learning CT Scan Analysis Predicts Brain Death Due to Trauma and Hypoxia

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