Predictors of survival and neurologic outcomes in children with traumatic out-of-hospital cardiac arrest during the early postresuscitative period

Lin, Yan Ren; Wu, Han; Chen, Wenliang; Wu, Kuan Han; Teng, Tsung Han; Yang, Min-Wen; Chou, Chia-Man; Chang, Chin‐Feng; Li, Chao Jui

doi:10.1097/ta.0b013e31829e2543

Cited by 34 publications

(29 citation statements)

References 24 publications

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“…29 Neurological clinical evaluation appears to be the main diagnostic tool when dealing with the probability of brain damage after cardiac arrest. This has been previously stated in other studies, [30][31][32][33] reflecting the difficulty of managing these patients after such a critical life-threatening event. Our results state that there is no common protocol that deals with managing these patients, trying to assess their outcome and establishing their follow-up.…”

Section: Discussionmentioning

confidence: 71%

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

et al. 2015

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Section: Discussionmentioning

confidence: 71%

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

et al. 2015

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“…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). For the important outcome of harm to patient, we identified no evidence.…”

Section: Consensus On Sciencementioning

confidence: 95%

“…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

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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...

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“…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: 99%