Retinal Hemorrhages Following Cardiopulmonary Resuscitation

Krämer, Kim; Goldstein, Brahm

doi:10.1177/000992289303200610

Cited by 42 publications

(19 citation statements)

References 10 publications

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“…5,11,12 Other physicians, however, have suggested that chest compressions performed during cardiopulmonary resuscitation (CPR) may cause retinal hemorrhages. 13,14 This is supported by one prospective study 14 and several anecdotal case reports. However, in nearly all cases the cardiopulmonary arrest was unwitnessed, and therefore, the etiology of the arrest is not accurately known.…”

mentioning

confidence: 76%

“…One case report describes an 17-month-old female infant who was evaluated for probable adenoviral gastroenteritis who had no retinal hemorrhages on her initial examination by an attending pediatrician. 13 This patient experienced a respiratory arrest and required approximately 60 minutes of chest compressions. She was transported to another hospital and on evaluation had multiple scattered intraretinal and subhyloid hemorrhages.…”

Section: Discussionmentioning

confidence: 99%

“…13,14,[22][23][24][25] Although one of these reports is a prospective evaluation of children who received CPR, most reports are anecdotes in which the arrests were not witnessed by anyone but the care giver. In fact, in the prospective study, one of the two arrests occurred out-of-hospital although the cause of the in-hospital arrest was unwitnessed and the diagnosis of sudden infant death was made.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

Odom¹,

Christ²,

Kerr

et al. 1997

Pediatrics

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ABSTRACT. Objective. Child abuse occurs in 1% of children in the United States every year; 10% of the traumatic injuries suffered by children under 5 years old are nonaccidental, and 5% to 20% of these nonaccidental injuries are lethal. Rapid characterization of the injury as nonaccidental is of considerable benefit to child protection workers and police investigators seeking to safeguard the child care environment and apprehend and prosecute those who have committed the crime of child abuse. Physically abused children present with a variety of well-described injuries that are usually easily identifiable. In some cases, however, particularly those involving children with the shaken baby syndrome, obvious signs of physical injury may not exist. Although external signs of such an injury are infrequent, the rapid acceleration-deceleration forces involved often cause subdural hematomas and retinal hemorrhages, hallmarks of the syndrome. Frequently, retinal hemorrhages may be the only presenting sign that child abuse has occurred. Complicating the interpretation of the finding of retinal hemorrhages is the belief by some physicians that retinal hemorrhages may be the result of chest compressions given during resuscitative efforts. The objective of this study is to determine the prevalence of retinal hemorrhages after inpatient cardiopulmonary resuscitation (CPR) in pediatric patients hospitalized for nontraumatic illnesses in an intensive care unit.Design. Prospective clinical study. Setting. Pediatric intensive care unit. Patients. Forty-three pediatric patients receiving at least 1 minute of chest compressions as inpatients and surviving long enough for a retinal examination. Patients were excluded if they were admitted with evidence of trauma, documented retinal hemorrhages before the arrest, suspicion of child abuse, or diagnosis of neardrowning or seizures. All of the precipitating events leading to cardiopulmonary arrest occurred in our intensive care unit, eliminating the possibility of physical abuse as an etiology.Interventions. None. Measurements. Examination of the retina was performed by one of two pediatric ophthalmologists within 96 hours of CPR. The chart was reviewed for pertinent demographic information; the platelet count, prothrombin time, and partial thromboplastin time proximate to the CPR were recorded if they had been determined.Results. A total of 43 pediatric patients hospitalized with nontraumatic illnesses survived 45 episodes of inpatient CPR. The mean age was 23 months (range, 1 month to 15.8 years), and 84% of the patients were under 2 years old. The majority of the patients (44%) were admitted to the intensive care unit after surgery for congenital heart disease, and another 21% were admitted for respiratory failure. The mean duration of chest compressions was 16.4 minutes ؎ 17 minutes with 58% lasting between 1 and 10 minutes. Five patients had chest compressions lasting >40 minutes, and two patients had open chest cardiac massage. All patients survived their resuscitative efforts. Nin...

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mentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

Odom¹,

Christ²,

Kerr

et al. 1997

Pediatrics

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“…192,203,206 Second, the reported complication rate from chest compressions in infants and children is low. [207][208][209][210][211][212][213][214] After publication of the 1992 ECC Guidelines, additional investigators evaluated the reliability of the pulse check with adult manikin simulation 198 in unconscious adult patients undergoing cardiopulmonary bypass, 202 unconscious mechanically ventilated adult patients, 199 and conscious adult "test persons." 194,201 These studies concluded that as a diagnostic test for cardiac arrest, the pulse check has serious limitations in accuracy, sensitivity, and specificity.…”

Section: Assessment: No Pulse Check For Lay Rescuersmentioning

confidence: 99%

Part 9: Pediatric Basic Life Support

2000

Circulation

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• The extremely complex skills sequence for lay rescuer relief of foreign-body airway obstruction (FBAO) in the unconscious victim has been simplified. The sequence for healthcare provider relief of FBAO in the unconscious victim remains unchanged (Class IIb). IntroductionPediatric BLS refers to the provision of CPR, with no devices or with bag-mask ventilation or barrier devices, until advanced life support (ALS) can be provided. The population addressed in this chapter includes infants from birth to 1 year of age and children from 1 to 8 years of age. CPR and life support in the pediatric age group should be part of a community-wide Chain of Survival that links the child to the best hope of survival following emergencies. The Chain of Survival integrates education in prevention of cardiopulmonary arrest, BLS, early access to EMS systems prepared for children's needs, early and effective pediatric Sudden cardiopulmonary arrest in infants and children is much less common than sudden cardiac arrest in adults. 4 In contrast to cardiac arrest in adults, cardiac arrest in infants and children is rarely a sudden event, and non-cardiac causes predominate. 4 The etiology of cardiac arrest in infants and children varies by age, setting, and the underlying health of the child. For these reasons, the sequence of CPR for infants and children requires a different approach from that used for adult victims.Cardiac arrest in the under-21-year-old age group occurs most commonly at either end of the age spectrum: under 1 year of age and during the teenage years. In the newly born infant, respiratory failure is the most common cause of cardiopulmonary deterioration and arrest. During infancy the most common causes of arrest include sudden infant death syndrome (SIDS), respiratory diseases, airway obstruction (including foreign-body aspiration), submersion, sepsis, and neurological disease. [5][6][7][8][9][10][11] Beyond 1 year of age, injuries are the leading cause of death. [12][13][14] Cardiac arrest in children typically represents the terminal event of progressive shock or respiratory failure. Either shock or respiratory failure may include a compensated state from which children can rapidly deteriorate to a decompensated condition with progression to respiratory or cardiac arrest. Therefore, rescuers must detect and promptly treat early signs of respiratory and circulatory failure to prevent cardiac arrest. In children, early effective bystander CPR has been associated with successful return of spontaneous circulation and neurologically intact survival. 15,16 BLS courses should be offered to target populations such as expectant parents, child care providers, teachers, sports supervisors, and others who regularly care for children. Parents and child care providers of children with underlying conditions that predispose them to cardiopulmonary failure should be particularly targeted for these courses.These guidelines are based on a review and analysis of clinical and experimental evidence. 17 Because this evidence varies widely...

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“…Séries subseqüentes de até 3 choques, em seguida à administração de medicação, é baseada no costume local e treinamento (isto é, 1ª desfibrilação até 3 vezes Complicações da RCP -Complicações relatadas das técnicas de ressuscitação apropriadas são raras em lactentes e crianças. A prevalência de efeitos adversos significantes (fraturas de costela, pneumotórax, pneumoperitônio, hemorragia, hemorragia retiniana, etc) de RCP, adequadamente realizada, parece ser muito menor em crianças que em adultos [59][60][61][62][63][64][65][66] . No mais recente estudo 59 , apesar de prolongada RCP por socorristas com variável habilidade e treinamento, complicações médicas significantes foram documentadas em somente 3% dos pacientes.…”

Section: Suporte Avançado De Vida Em Pediatriaunclassified

Suporte de vida em pediatria

Hazinski¹,

Zideman²,

Kattwinkel³

et al. 1998

Arq. Bras. Cardiol.

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Este breve documento reflete a deliberação do Grupo de Trabalho Pediátrico do Comitê Internacional de Ressuscitação de Liaison (CIRL) ou ILCOR. A meta do CIRL é aperfeiçoar, de forma consistente, as normas publicadas pelas associações e conselhos internacionais de ressuscitação. A proposta deste documento é esclarecer áreas de conflito ou controvérsia das normas de suporte de vida básico e avançado em pediatria disponíveis [1][2][3][4][5] , esboçar soluções consideradas e recomendações alcançadas por consenso do Grupo de Trabalho. Listamos, também, questões não resolvidas e apresentamos algumas áreas de interesse em pesquisa e investigação destas normas. Este documento não inclui lista completa das normas, no que se refere aos tópi-cos nos quais não foram detectadas controvérsias. Os algoritmos apresentados tentam ilustrar um fluxo comum de avaliações e intervenções. Sempre que possível, estes têm sido considerados como complemento dos algoritmos de Suporte Básico de Vida (SBV) e Suporte Avançado de Vida (SAV) utilizados em pacientes adultos. Uma vez que a parada cardiorrespiratória (PCR) no recém-nascido apresenta desafios peculiares na ressuscitação, com relação à sua etiologia, fisiologia e pesquisas necessárias, desenvolvemos uma seção separada dirigida para ressuscitação inicial do recém-nascido. Outras áreas de partida do algoritmo de adulto foram constatadas e estão explicadas no texto.Na ausência de dados pediátricos específicos, as recomendações podem ser feitas ou apoiadas com base no senso comum ou na facilidade de ensinar ou reter a habilidade. A viabilidade prática das recomendações no contexto dos recursos locais (tecnológico e pessoal) e costumes devem sempre ser considerados. Na execução deste documento foi surpreendente para os participantes do grupo de trabalho como são pequenas as diferenças existentes entre as normas pediátricas correntes, divulgadas pela American Heart Association, Heart and Stroke Foundation of Canada, European Resuscitation Council, Australian Resuscitation Council e Resuscitation Council of Southern Africa. RetrospectivaA epidemiologia e evolução da PCR em pediatria, assim como as prioridades, técnicas e seqüência das avaliações e intervenções na ressuscitação pediátrica diferem dos adultos. Em vista disso, torna-se imperativo que toda norma desenvolvida para ressuscitação pediátrica dirija-se para as necessidades específicas do recém-nascido, lactente, criança e adolescente. Infelizmente, dados específicos, respeitando essas diferenças, têm sido deficientes tanto em quantidade como em qualidade, por várias razões: a) parada cardíaca pediátrica é pouco freqüente; b) na maioria das vezes a sobrevida de parada cardíaca em assistolia em crianças é muito baixa; c) a maioria dos estudos em pediatria apresenta falha quanto à utilização de critérios consistentes de inclu-* não se responsabiliza pela tradução

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Retinal Hemorrhages Following Cardiopulmonary Resuscitation

Cited by 42 publications

References 10 publications

Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

Part 9: Pediatric Basic Life Support

Suporte de vida em pediatria

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