Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest

Lin, Yan Ren; Li, Chao Jui; Wu, Tung‐Kung; Chang, Yu-Jun; Liu, Tzu An; Hsiao, Ming Hau; Chou, Chia-Man; Chang, Chin‐Feng

doi:10.1016/j.resuscitation.2010.01.006

Cited by 42 publications

(26 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For the important outcome of survival to hospital discharge, we identified very-low-quality evidence from 3 pediatric observational studies of IHCA and OHCA (downgraded for risk of bias, inconsistency, indirectness, and imprecision) [97][98][99] involving a total of 615 subjects, showing worse outcomes when children experienced hypotension after ROSC. Significant heterogeneity (I-squared value 0.87) did not support pooling the data from these 3 studies (Topjian 97 : OR, 0.62; 95% CI, 0.41-0.93; Lin 98 : OR, 0.10; 95% CI, 0.03-0.32; and Lin 99 : OR, 0.07; 95% CI, 0.02-0.25).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

Caen¹,

Maconochie²,

Aickin³

et al. 2015

Circulation

152

View full text Add to dashboard Cite

The Pediatric Task Force reviewed all questions submitted by the International Liaison Committee on Resuscitation (ILCOR) member councils in 2010, reviewed all council training materials and resuscitation guidelines and algorithms, and conferred on recent areas of interest and controversy. We identified a few areas where there were key differences in council-specific guidelines based on historical recommendations, such as the A-B-C (Airway, Breathing, Circulation) versus C-A-B (Circulation, Airway, Breathing) sequence of provision of cardiopulmonary resuscitation (CPR), initial back blows versus abdominal thrusts for foreign-body airway obstruction, an upper limit for recommended chest compression rate, and initial defibrillation dose for shockable rhythms (2 versus 4 J/kg). We produced a working list of prioritized questions and topics, which was adjusted with the advent of new research evidence. This led to a prioritized palate of 21 PICO (population, intervention, comparator, outcome) questions for ILCOR task force focus.The 2015 process was supported by information specialists who performed in-depth systematic searches, liaising with pediatric content experts so that the most appropriate terms and outcomes and the most relevant publications were identified. Relevant adult literature was considered (extrapolated) in those PICO questions that overlapped with other task forces, or when there were insufficient pediatric data. In rare circumstances (in the absence of sufficient human data), appropriate animal studies were incorporated into reviews of the literature. However, these data were considered only when higher levels of evidence were not available and the topic was deemed critical.When formulating the PICO questions, the task force felt it important to evaluate patient outcomes that extend beyond return of spontaneous circulation (ROSC) or discharge from the pediatric intensive care unit (PICU). In recognition that the measures must have meaning, not only to clinicians but also to parents and caregivers, longer-term outcomes at 30 days, 60 days, 180 days, and 1 year with favorable neurologic status were included in the relevant PICO questions.Each task force performed a detailed systematic review based on the recommendations of the Institute of Medicine of the National Academies 1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) working group.2 After identifying and prioritizing the questions to be addressed (by using the PICO format) 3 with the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk-of-bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnosti...

show abstract

Section: Consensus On Sciencementioning

confidence: 99%

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

Caen¹,

Maconochie²,

Aickin³

et al. 2015

Circulation

152

View full text Add to dashboard Cite

show abstract

“…Laktat (mmol/L) 3 6,9 <0,001 (0,2-20) (3,(9)(10)(11)(12) dığı rapor edilmektedir (12)(13)(14)(15). Çalışmamızda ise cinsiyet bir risk faktörü olarak belirlenmemiş; fakat ilk 24 saatte ölen hastaların yaşlarının daha küçük olduğu görülmüştür.…”

Section: Discussionunclassified

“…Erişkin hastalarda, acil servise ilk başvuru sırasında elde edilen kan amonyak ve laktat düzeylerinin canlandırma işlemi sonucunu tahmin etmede faydalı olduğu belirtilmektedir. Tüm bu parametreler doku hipoksisini, asfiksiyi ve şiddetli stresi göstermekte olup uzamış canlandırma süresi ve yüksek epinefrin enjeksiyon sayısıyla uyumludur (11,12,13 Sonuç olarak acil serviste ileri yaşam desteği uygulanan çocuk hastalarda artmış epinefrin enjeksiyon sayısı ve yüksek kan laktat düzeyinin ilk 24 saatteki mortaliteyi öngörmede etkin olduğu saptanmıştır. Çocuk acil servislerinde canlandırma uygulaması yapılan hastaların mortalite risklerini öngör-mede kullanılacak bir skorlama sistemi faydalı olacaktır.…”

Section: Discussionunclassified

Early Mortality Predictors for Children Receiving Advanced Life Support in Emergency Department

Anıl¹,

Köse²,

Köse³

et al. 2014

Turk J Ped Em Int Care Med

View full text Add to dashboard Cite

ÖZETAmaç: Acil serviste ileri yaşam desteği uygulanan çocukların özelliklerinin, prognostik faktörlerin ve erken dönem sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 01.06.2011 ile 31.05.2012 tarihleri arasında acil serviste ileri yaşam desteği uygulanan çocuk-lar geriye dönük olarak değerlendirilmiştir. Hastaların klinik özellikleri, başvuru anında elde edilen laboratuvar değişkenleri ve ilk 24 saat içindeki mortalite belirteçleri analiz edilmiştir. Bulgular: İleri yaşam desteği sıklığı %0,03'dür. Hastaların 16'sı travma hastası olup, 21'nde kronik hastalık mevcuttur. İleri yaşam desteği uygulanan 46 hastanın 15'i ilk 24 saat içinde ölmüştür. Ölen ve yaşayan hastaların ortanca yaşları sırasıyla 8 ve 30 aydır (p<0,05). İlk 24 saat içinde yaşayan ve ölen hastalar arasında, epinefrin enjeksiyon sayısı, kan glikoz, C-reaktif protein, bikarbonat, baz fazlalılığı ve laktat düzeyleri anlamlı olarak farklıdır (p<0,05). Lojistik regresyon analizinde, yüksek epinefrin enjeksiyon sayısı ve yüksek kan laktat düzeyi erken dönem mortalitenin göstergesidir (p<0,05). ROC analizinde, epinefrin enjeksiyon sayısı ve kan laktat düzeyi için eğri altında kalan alanın büyüklüğü sırasıyla 0,900 ve 0,883'dür. Sonuç: Epinefrin enjeksiyon sayısı ve acil servise başvuru sırasında elde edilen kan laktat düzeyi ilk 24 saat içinde-ki mortalite göstergeleridir (CAYD 2014; 1(1):17-24). Anahtar Kelimeler: İleri yaşam desteği, çocuk acil servisi, epinefrin, laktat SUMMARY Introduction : The characteristics, prognostic factors and early outcomes were evaluated for children receiving advanced life support in emergency department. Material and Methods :We retrospectively evaluated the medical records of 46 children who received advanced life support in emergency department between 06. 01.2011 -05. 31.2012. The clinical and laboratory variables that were available at admission and the predictors of mortality in first 24 hours were analyzed. Results: The incidence of advanced life support was %0,03. Sixteen of them were trauma patients and 21 children had chronic disease. Among the 46 children who received advanced life support, 15 patients were died in first 24 hours. The median age of patients who died and survived were 8 and 30 months (p<0.05). The number of epinephrine injections, the blood levels of glucose, C-reactive protein, bicarbonate, base excess and lactate were significantly different between the survived and death patients in first 24 hours (p<0,05). In logistic regression analysis, the higher numbers of epinephrine injections and higher levels of blood lactate level were identified as predictors of early mortality (p<0.05). The areas under the curve of number of epinephrine injection and blood lactate level were 0.900 and 0.883 in ROC analysis. Conclusions:The number of epinephrine injection and blood lactate level at arrival to the emergency department are the predictors of death in first 24 hours (CAYD 2014; 1(1):17-24).

show abstract

“…survival to hospital discharge with good neurological outcome (RR 0.78; 95% CI 0.62-0.99). Two other paediatric observational studies (102,103) of IHCA and OHCA involving a total of 615 children showed worse outcomes (survival to hospital discharge) in patients who experienced hypotension after ROSC. There was significant heterogeneity (I-squared value 0.87), which does not support pooling of data from the aforementioned studies (Topjian: OR 0.62; 95% CI 0.41-0.93; Lin: OR 0.10; 95% CI 0.03-0.32; and Lin: OR 0.07; 95% CI 0.02-0.25).…”

Section: (C) Post-rosc Fluid and Inotrope Therapymentioning

confidence: 98%