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  • 1
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    Abstract 287: Trends In Cardiac Arrest Outcomes In Children With Cardiac Disease: An Analysis From The Aha Get With The Guidelines ® Database
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Contemporary rates of survival after pediatric in-hospital cardiac arrest (IHCA) and trends in survival over the last 20 years have not been compared based on illness category. We hypothesized that (1) survival to hospital discharge for surgical-cardiac category is higher than the non-cardiac category, and (2) rates of survival after IHCA increased over time in all categories. Methods: The AHA Get With The Guidelines ® -Resuscitation database was queried for index IHCA events (excluding delivery room and neonatal intensive care unit) in children 〈 18 years of age from 2000-2021. Categories were defined as: surgical-cardiac, IHCA following cardiac surgery; medical-cardiac, IHCA in non-surgical cardiac disease; and non-cardiac, IHCA in patients without cardiac disease. The primary outcome was survival to hospital discharge. We compared eras 2000-2004, 2005-2009, 2010-2014, and 2015-2021 with mixed logistic regression models, including event year as a continuous predictor and site as a random effect. Results: Of 17,696 index events, IHCA by illness category were: 18% surgical-cardiac, 18% medical-cardiac, and 64% non-cardiac. Surgical-cardiac category had the highest rate of survival to discharge compared to medical-cardiac and non-cardiac categories (56.1% vs. 43.4% vs. 46.3%; p 〈 0.001). After controlling for age, location of event, and hospital size, the odds of survival were higher for surgical-cardiac category (aOR 1.28 (1.16, 1.40)) and lower for medical-cardiac category (aOR 0.87 (0.80, 0.95)), compared to the non-cardiac category. Odds of survival increased for all illness categories across eras. Between the 2000-2004 and 2015-2021 eras, survival in surgical-cardiac subjects increased from 45.6% to 62.3% with odds of survival increasing by 24% per era, (OR 1.24 (95% CI 1.15, 1.35), and survival for medical-cardiac subjects increased from 36.6% to 47.0%, with 14% increased odds per era (OR 1.14 (1.06, 1.23)). Conclusions: Over the last 20 years, children with surgical-cardiac IHCA have substantially higher odds of survival to hospital discharge compared to non-cardiac IHCA categories, whereas odds of survival were worse with medical-cardiac IHCA. Survival to hospital discharge has increased in all IHCA illness categories.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.287
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
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    Abstract 246: Defibrillation For Pulseless Ventricular Arrhythmias During Pediatric In-hospital Cardiac Arrest: A Report From The AHA Get With The Guidelines ® -Resuscitation Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Approximately 15,200 children suffer an in-hospital cardiac arrest (IHCA) annually, and 10-20% will have ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT). Timely defibrillation is critical for shockable rhythms, however current data are lacking on outcomes when 〉 1 shock is required for termination of VF/pVT. Methods: From the AHA Get With The Guidelines ® -Resuscitation registry, we identified children 〈 18 years of age who had IHCA from initial VF/pVT and received 〉 1 shock from 2000-2020. Patients were analyzed according to total number of shocks received: 2 shocks, 3 shocks, or 〉 4 shocks. Multivariable logistic regression models were used to test the association between number of shocks and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with favorable neurologic outcome. Results: 436 patients met inclusion criteria and received 〉 1 shock for VF/pVT. Median age was 8 years [IQR, 0.9,15.0]. Patients that required 〉 4 shocks were older patients (11 years [1.0-15.0; p=0.013]). A higher percentage of patients receiving 〉 4 shocks had renal insufficiency (14% vs. 7% for 2 shocks vs. 6% for 3 shocks, p = 0.041). Patients receiving 〉 4 shocks vs. 2 shocks were less likely to achieve ROSC (OR 0.40 [0.23,0.68]; p=0.0009). There was no statistically significant difference in survival to hospital discharge for patients receiving 2 shocks (42%), 3 shocks (39%), or 〉 4 shocks (32%) or survival to hospital discharge with favorable neurologic outcome. Conclusion: There was no significant association between the number of shocks and survival to hospital discharge or survival to hospital discharge with favorable neurologic outcome. ROSC was significantly less in patients with 〉 4 shocks for VF/pVT compared to 2 shocks. Further research is needed to characterize energy dosing when 〉 1 shock is needed for VF/pVT.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.246
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 3
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    Abstract 150: Effect of Amplitude Spectral Area on Termination of Fibrillation and Outcomes in Pediatric Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_4 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_4 ( 2020-11-17)
    Abstract: Introduction: Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and hospital survival in adults, but has not been studied during pediatric cardiac arrest (pCA). Hypothesis: We characterized AMSA during pCA from a pediatric resuscitation quality (pediRES-Q) collaborative and hypothesized that AMSA would be associated with TOF and ROSC. Methods: Children 〈 18 years of age with pCA and VF were studied. AMSA was measured for 2 seconds prior to each shock and also averaged for each subject (AMSA-avg). TOF was defined as termination of VF 10 secs after defibrillation (DF) to any rhythm other than VF. ROSC was defined as 〉 20 mins without chest compressions. Univariate and multivariable logistic regression analyses controlling for weight, current, and illness category (cardiac vs non-cardiac) were performed. Primary endpoints were TOF and ROSC without ECMO. Secondary endpoints were 24-hr survival and survival to hospital discharge. Results: Between 2015-2019, 50 children from 14 hospitals (median age 3.7 years [IQR 0.6, 13.1]; median weight 16.3 kgs [IQR 6.9, 37.2] ; 46% male; 73% cardiac illness category) were identified. IHCA occurred in 47 children and OHCA in 3 children. We analyzed 111 shocks with median number of DFs 1.0 [IQR 1.0, 3.0], median DF energy dose 3.27 J/kg [IQR 2.65,5.01] , median DF current 0.64 A/kg [IQR 0.38,0.96], median AMSA 12.21 [IQR 7.17,17.03] , and median AMSA-avg 14.6 [IQR 8.6,19.2]. TOF was achieved in 72 DFs (65%), ROSC without ECMO in 31 (62%), ROC with ECMO in 11 (22%), 24-hr survival in 40 (80%), and survival to hospital discharge in 26 (52%). Weight (OR 0.91 [0.84, 0.99] P=0.025) and DF current (OR 1.44 [0.97, 2.2] P=0.07), but not AMSA, were significantly associated with TOF for the first shock. Controlling for DF current and illness category, there was a significant association between AMSA-avg (OR 1.11 [1.0, 1.24] P=0.044) and ROSC without ECMO. There was no significant association between AMSA-avg and 24-hr survival or survival to hospital discharge. Conclusions: In pediatric patients, TOF was associated with weight and DF current, but not AMSA, whereas AMSA-avg was associated with ROSC without ECMO, but not 24-hr survival or survival to hospital discharge.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_4.150
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 4
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    Abstract 108: Pulselessness Despite Cardiopulmonary Resuscitation for Bradycardia in Hospitalized Children: Prevalence, Predictors of Survival, and Implications for Hospital Profiling
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Circulation Vol. 138, No. Suppl_2 ( 2018-11-06)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 138, No. Suppl_2 ( 2018-11-06)
    Abstract: Background: Cardiopulmonary resuscitation (CPR) is initiated in hospitalized children with bradycardia and poor perfusion. However, it is unknown how often these children progress to pulseless in-hospital cardiac arrest (IHCA) despite CPR, and whether survival differs from primary pulseless IHCA. Methods: In Get With The Guidelines-Resuscitation (2000-2016), we identified all pediatric patients (age 〉 30 days, 〈 18 years) receiving CPR, and assessed the prevalence and predictors of survival among those progressing from bradycardia to pulselessness after initiation of CPR using multilevel Poisson regression that accounted for the pulseless rhythm. Results: Overall, 5592 pediatric patients were treated with CPR, of whom over half (2799) were for bradycardia with poor perfusion and the remaining 2793 were primary pulseless IHCAs. Among those with bradycardia, 869 (31%, or 16% of entire cohort) progressed to pulselessness after a median of 3 min of CPR (IQR 1- 9). Survival to discharge was 70% for bradycardia without pulselessness, 30% with bradycardia progressing to pulselessness, and 38% with primary pulseless IHCA (P 〈 .001). Children who became pulseless while receiving CPR for bradycardia had a 19% lower likelihood (RR 0.81 [0.70 - 0.93]) of surviving to hospital discharge than those initially pulseless. Among children who progressed to pulselessness while receiving CPR for bradycardia, longer time to pulselessness was an independent predictor of lower survival (ref: 〈 2 min, for 2-5 min: RR 0.54 [0.41 - 0.70]; for 〉 5 min: RR 0.41 [0.32 - 0.53], Figure ). Conclusions: Among non-neonatal pediatric patients in whom CPR is initiated, half have bradycardia with poor perfusion, and nearly one-third of these progress to IHCA despite CPR. Survival was lower for pediatric patients who subsequently became pulseless as compared to those who were initially pulseless. These findings have implications for care delivery and profiling hospital performance for pediatric IHCA.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.138.suppl_2.108
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 5
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    Abstract 133: Association of End Tidal Carbon Dioxide 〉20mmhg with Pediatric In-hospital Cardiac Arrest Quality of Cpr and Survival
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_4 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_4 ( 2020-11-17)
    Abstract: Introduction: AHA recommends titrating chest compressions (CC) to achieve end-tidal carbon dioxide (ETCO2) 〉 20mmHg, based on laboratory, adult, and very limited pediatric IHCA data. Hypothesis: ETCO2 〉 20mmHg averaged during the first 10 min of recorded CPR is associated with 1) compliance with AHA CC depth quality targets, and 2) survival to hospital discharge. Methods: All pediatric 2015-2019 IHCA events reported by 4 pediRES-Q sites with simultaneous ETCO2 and CC metrics (ZOLL R-Series defibrillator) measured. Analysis included the first 10 min of CPR with CC data recorded using dual sensor accelerometers that compensate for mattress deflection. Compliance with 2015 AHA guidelines CC depth quality target defined as ∼1/3 estimated AP diameter: ≥3.4 cm for infants 〈 1yr, ≥4.4cm for 1 to 〈 8yrs, and 4.5-6.6cm for 8 to ≤ 18yrs. Primary analysis for ETCO2 〉 20mmHg cutoff association with CC depth and survival by modified Poisson regression models, accounting for age. Secondary analysis for mean ETCO2 (no a priori cutoff) association with CC depth and survival, adjusting for age. Results: Of 44 events (24 index): median 10-min averaged ETCO2 was 23 [IQR 13, 37] mmHg, CPR duration was 23 [IQR 10, 53] min, return of spontaneous circulation (ROSC) was 70% (31/44), and survival to hospital discharge was 33% (8/24). ETCO2 〉 20 mmHg cutoff was associated with CC depth [RR 1.55 (95%CI: 1.20,2.00) p=0.0007], and age-specific AHA depth quality target compliance [RR 1.01 (95%CI: 1.00,1.02) p=0.02. However, ETCO2 〉 20mmHg cutoff was not significantly associated with survival: ROSC [RR 1.08 (95%CI: 0.71, 1.65), p=0.72)] nor survival to hospital discharge [RR 1.10 (95%CI: 0.33, 3.65), p=0.87] . Mean 10-min averaged ETCO2 (no cutoff) was not significantly associated with CC depth (p=0.09), age-specific AHA depth quality target compliance (p=0.07), ROSC (p=0.57) , nor survival to hospital discharge (26 [IQR 14, 43] mmHg vs. 16 [IQR 13,34] mmHg non-survival to hospital discharge, p=0.28). Conclusions: In this multicenter pediatric In-hospital CPR cohort, ETCO2 〉 20mmHg cutoff averaged during the first 10-min of recorded CPR was significantly associated with CC depth and age-specific AHA depth quality target compliance, but not with ROSC or survival to hospital discharge.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_4.133
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Abstract 152: Cerebral Oximetry During Pediatric In-hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_4 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_4 ( 2020-11-17)
    Abstract: Introduction: Cerebral near-infrared spectroscopy (NIRS) measuring regional oxygen saturation (rSO 2 ) during cardiopulmonary resuscitation (CPR) is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in adults, with limited data in children. We hypothesized mean cerebral rSO 2 during pediatric in-hospital cardiac arrest (IHCA) would be associated with return of spontaneous circulation (ROSC). Methods: Consecutive case series of pediatric IHCA events with rSO 2 data reported between 2016-2020 by 3 sites to the Pediatric Resuscitation Quality (pediRES-Q) collaborative. We excluded patients with CPR duration ≤2 minutes or who had return of circulation via extracorporeal membrane oxygenation. We calculated mean rSO 2 for duration of CPR and the primary outcome measure was ROSC. Exploratory sensitivity analyses were performed for cutoffs of mean rSO 2 〉 25, 〉 30, 〉 35, 〉 40 and 〉 50%. Analysis was done using independent samples t test, Exact logistic regression and Fisher’s exact test. Results: Of 36 events (26 index), median age was 3 [IQR 1,7.8] months; 29 (80.5%) had congenital heart disease and 15 (41.7%) had single ventricle (SV) physiology. Median CPR duration was 7.5 [IQR 3.8, 32.2] minutes and 28/36 (77.8%) had ROSC. Mean intra-arrest cerebral rSO 2 was 44.2% (±19.5) for ROSC vs. 37.4% (±15) for non-ROSC group ( p =0.267). Using Exact logistic regression, there was no association found between rSO 2 and ROSC, even after controlling for age, presence of congenital heart disease, and SV physiology. Using mean rSO 2 cutoffs 〉 25, 〉 30, 〉 35, 〉 40, and 〉 50%, we found no significant association with ROSC. We found same result in the SV subgroup. Conclusion: In this small pediatric cohort of predominantly cardiac patients, there was no significant association between cerebral rSO 2 during pediatric cardiac arrest and ROSC, even after controlling for important confounders of age and SV physiology. More extensive studies using larger populations, and evaluating intra-arrest change in cerebral rSO 2 from baseline, are warranted to provide more insight into the possibilities of using rSO 2 to guide CPR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_4.152
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 7
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    Abstract 370: Delivery of CPR in Patients With Single and Biventricular Cardiac Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 140, No. Suppl_2 ( 2019-11-19)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 140, No. Suppl_2 ( 2019-11-19)
    Abstract: Introduction: Diminished survival after cardiopulmonary resuscitation (CPR) has been shown in patients with congenital heart disease (CHD) and single ventricle (SV) anatomy compared to biventricular anatomy (BV). The role guideline-compliant CPR plays in SV outcomes is unknown. Hypothesis: During pediatric in-hospital cardiac arrest (IHCA), there will be a difference in CPR delivery and outcomes of patients with SV compared to BV anatomy. Methods: Prospective observational cohort from 12 pediRES-Q sites of IHCA in children ≤ 18 years with CPR quality metric data (chest compression (CC) rate, depth, and fraction (CCF)) (Zoll R-Series, Chelmsford, MA). We compared 60-sec CC epoch compliance with 2015 American Heart Association guideline targets defined as: CC rate 100-120/min; depth ≥4.0 cm in 〈 1 yo, ≥5 to ≤6 cm in 1- 〈 18 yo; and CCF ≥0.80. Total guideline compliance was defined as a CC event with ≥ 60% epochs meeting all targets. Metric summaries were reported as median [IQR] and compliance as frequency (%). Differences were assessed using Wilcoxon rank-sum and Fishers exact tests, respectively. Logistic regression assessed for associations with outcomes, including anatomy and proportion of guideline-compliant CPR. Results: From 10/2015 to 3/2019, we analyzed 82 events ( 〉 5 epochs) in patients with CHD. Thirty-seven percent had SV anatomy and more SV patients were post-operative (70% vs 2%). There were no differences in time to first epinephrine dose (1 vs 2 min), shockable rhythm (7% vs 6%), or need for ECMO (27% vs 23%). Total guideline compliance across all ages was not different (SV 10.0% vs BV 5.8%, P=0.67) and not associated with ROSC or survival to hospital discharge (SHD). There was a 75% lower adjusted odds of SHD in 1- 〈 8 yo vs 〈 1 yo. Conclusion: There were no meaningful differences in resuscitative practice or delivery of guideline-compliant CPR in those with SV versus BV anatomy. Guideline-compliant CPR was not associated with outcomes regardless of cardiac anatomy.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.140.suppl_2.370
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 8
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    Abstract 12: Outcomes After Pediatric Extracorporeal Cardiopulmonary Resuscitation: Do Quantitative CPR Metrics Matter?
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 140, No. Suppl_2 ( 2019-11-19)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 140, No. Suppl_2 ( 2019-11-19)
    Abstract: Introduction: Duration of conventional cardiopulmonary resuscitation (CPR) prior to ECMO cannulation (ECPR) has been shown to be associated with worse survival outcomes, yet conflicting reports exist. Hypothesis: ECPR patients who receive guideline-compliant CPR will have improved survival to hospital discharge (SHD) compared to patients who do not receive guideline-compliant CPR, regardless of CPR duration. Methods: Prospective cohort from PediRES-Q sites of IHCA in children ≤ 18 yo requiring ECMO to achieve ROSC. We assessed compliance of 60-sec chest compression (CC) epochs via metric data (Zoll R-series, Chelmsford, MA) with 2015 AHA guideline targets. Guideline-compliant CPR was defined as an IHCA with 〉 60% epochs meeting compliance criteria for metric data. Differences were assessed utilizing Wilcoxon rank-sum and Chi-square tests. Logistic regression assessed the association between compliance and SHD, adjusting for age, arterial line, and duration of CPR. Results: From 10/2015 to 3/2019, 62 index ECPR events ( 〉 5 epochs) in 20 infants ( 〈 1 yo), 24 children (1- 〈 8 yo), and 18 adolescents (8-≤18 yo) with CPR quality metric data were utilized from 15 sites. Median CPR duration 52 mins (IQR 45,70), median weight 11.6 kgs (IQR 6.8,29.8), and 38/62 patients (61%) had a cardiac diagnosis. Guideline compliance was not associated with SHD. Adjusting for age, presence of arterial line, and duration of CPR, guideline compliance was not significantly associated with SHD. However, age and duration of CPR were significantly associated to SHD, as 8- 〈 18 yo had 85% lower odds of SHD than 〈 1 yo (aOR=0.15 {0.03, 0.73}; P=0.019) and every minute increase in duration of CPR decreased odds of survival by 4% (aOR=0.96 {0.94,0.99}; P=0.009). Conclusion: No SHD benefits were found among ECPR patients who received guideline-compliant CPR compared to patients who do not. Older patients and those with longer CPR duration had worse SHD outcomes irrespective of guideline-compliant CPR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.140.suppl_2.12
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 9
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    Abstract 9764: Prevalence of Inappropriate Defibrillation Attempts During Pediatric In-Hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Introduction: Shockable rhythms (ventricular fibrillation [VF] and ventricular tachycardia [VT] ) occur in 〈 25% of pediatric in-hospital cardiac arrest (IHCA) events, yet the prevalence of inappropriate defibrillation attempts for non-VF/VT rhythms is unknown. We aim to describe the prevalence of inappropriate shocks across a large, multi-national pediatric cardiac arrest network. Methods: We included children 〈 18y reported to the pedi atric RES uscitation- Q uality (pediRES-Q) network from 2015-2019 with complete defibrillator files who received defibrillation attempts during IHCA (ZOLL R-Series, MA). Two pediatric cardiologists independently classified rhythms immediately prior to shock as: 1) appropriate (VF or wide complex ≥ 150/min), 2) indeterminate (narrow complex ≥150/min or wide complex 100-149/min), or 3) inappropriate (asystole, sinus, narrow complex 〈 150/min, or wide complex 〈 100/min). Rhythms that were undecipherable due to artifact were excluded from analysis (n=22). Disagreements were resolved by arbitration and consensus. Results: Of 896 IHCA events, 124 (14%) had defibrillation attempts. A total of 303 shocks were delivered: 87 (29%) in age 〈 1y, 84 (28%) in 1-8y, and 132 (44%) in 9-17y. Of shocks delivered, 206 (68%) were appropriate, 12 (4%) indeterminate, and 85 (28%) inappropriate. There was no difference in inappropriate shock delivery by age category: 〈 1y (24/87, 28%), 1-8y (26/84, 31%), 9-17y (35/132, 27%) ( p =0.4). Conclusions: Across a multi-national pediatric cardiac arrest network, a large proportion (28%) of defibrillation attempts were inappropriate, suggesting significant opportunity for improvement in rhythm identification in pediatric cardiac arrest. There was no difference in inappropriate shock delivery across age groups. Figure 1. Representation of rhythm classification and appropriateness of defibrillation attempts with exemplar rhythms.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.9764
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Abstract 17573: Epinephrine Dosing Interval and Survival Outcomes During Pediatric In-hospital Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Background: American Heart Association (AHA) guidelines recommend administration of epinephrine (epi) every 3 to 5 minutes during CPR to improve systemic blood pressure and coronary perfusion pressure. In adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to hospital discharge. The purpose of this study is to investigate whether longer epi dosing intervals are associated with improved survival to hospital discharge after pediatric IHCA. Methods: A retrospective review of the AHA Get With The Guidelines-Resuscitation registry identified 1,260 pediatric IHCAs that met our inclusion criteria: index IHCA event; no vasoactive infusion in place or alternate vasoactive medication boluses; 〉 1 dose of epi administered; not located in delivery room, nursery, NICU or obstetrical units. For each arrest, an epi dosing interval was defined by dividing the duration of resuscitation after the first dose of epi by the total doses given. This was necessary as the database does not provide time of individual epi doses. For analysis, epi dosing intervals were categorized as 1 to 〈 5 minutes/dose, 5 to 〈 8 minutes/dose, and 8 to 10 minutes/dose. Multivariable logistic regression models were constructed controlling for age, gender, illness category, location of arrest, and arrest duration to evaluate the relationship of epi dosing intervals on survival to discharge. Odds ratios were calculated using the 1 to 〈 5 minutes/dose interval as the reference. Results: Table 1 displays the descriptive characteristics of the patients and subsequent events. Adjusted odds ratio for survival to hospital discharge for dosing interval of 5 to 〈 8 minutes was 1.454 (95% CI 1.014-2.084) and for 8 to 10 minutes was 1.945 (95% CI 1.094-3.459). Conclusions: Longer dosing intervals than those currently recommended by the AHA guidelines for epinephrine administration during pediatric IHCA are associated with improved survival to hospital discharge.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.17573
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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