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  • 1
    Online Resource
    Online Resource
    Abstract 321: Sodium Bicarbonate Use During In-hospital Pediatric Cardiopulmonary Resuscitation - A Report From the American Heart Association Get With The Guidelines-Resuscitation®
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 6, No. suppl_1 ( 2013-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. suppl_1 ( 2013-05)
    Abstract: OBJECTIVES: The 2005 and 2010 Pediatric Advanced Life Support (PALS) Guidelines do not recommend using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR) except for select resuscitation situations. We hypothesize that SB is used frequently during in-hospital pediatric CPR and its use is associated with worse survival to hospital discharge when given outside of these recommended resuscitation situations. PATIENTS AND METHODS: We analyzed data from 8602 consecutive pediatric CPR events (patients 〈 18 yrs) submitted to the American Heart Association Get With The Guidelines-Resuscitation from January 2000 through September 2010. The primary outcome was survival to hospital discharge. Secondary outcomes included event survival, 24 hr survival, and neurologic outcome. Multivariable logistic regression was performed to analyze the association between SB use and outcomes. RESULTS: SB was used in 3923 (46%) of 8602 events. The incidence of SB use between 2000-2005 vs. 2006-2010 was 54% vs. 41% (p 〈 0.001; Fig. 1). After adjustment for confounding factors (e.g. event location, illness category, arrest rhythm, concurrent advanced cardiac life support medications, and duration of CPR 〉 15 mins), the use of SB during CPR was associated with decreased survival to discharge (OR: 0.62; 95% CI: 0.54, 0.71), but not unfavorable neurologic outcome (OR 0.73; 95% CI 0.50, 1.05). In the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities/overdose /poisoning, and high potassium, SB use during CPR was not associated with worse survival to discharge (OR: 0.78; 95% CI: 0.56; 1.09) or unfavorable neurologic outcome (OR 1.05; 95% CI: 0.37, 2.97). After excluding patients in the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities, and hyperkalemia, SB use during CPR (n = 5270) continued to be associated with worse survival to discharge (OR: 0.61; 95% CI: 0.53, 0.71) and unfavorable neurologic outcome (OR: 0.64; 95% CI: 0.43, 0.95). CONCLUSIONS: Sodium bicarbonate continues to be used frequently during in-hospital pediatric CPR, yet there is a significant trend towards less routine use over the last decade. Sodium bicarbonate use is associated with decreased survival to hospital discharge and unfavorable neurologic outcome when given outside PALS recommendations.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.6.suppl_1.A321
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2453882-6
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  • 2
    Online Resource
    Online Resource
    Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age 〈 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97] , per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.44
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1466401-X
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