scholarly journals Pediatric Resuscitation: Outcome Effects of Location, Intervention, and Duration

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
John P. Scott ◽  
Lindsey Loveland Baptist ◽  
Richard J. Berens
Keyword(s):  
Cardiac Arrest ◽  
Survival Data ◽  
Oxygen Delivery ◽  
Organ Injury ◽  
System Failure ◽  
Critical Importance ◽  
Neurologic Outcomes ◽  
Anoxic Injury ◽  
Pediatric Resuscitation ◽  
The Brain

Cardiopulmonary resuscitation (CPR) is performed in order to restore oxygen delivery and prevent multiorgan system failure and death. Prompt initiation of CPR with appropriate medical or surgical therapy may shorten arrest duration before irreversible organ injury occurs. The brain is most susceptible to irreversible anoxic injury. Survival data suggests that children are more likely than adults to survive and have good neurologic outcomes following cardiac arrest. In this review of pediatric resuscitation, we discuss important predictors of postarrest outcomes as well as advances in resuscitation science focusing on the critical importance of oxygen delivery during periarrest care.

scholarly journals Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest

Children ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. 52 ◽  
Author(s):  
Munmun Rawat ◽  
Praveen Chandrasekharan ◽  
Sylvia Gugino ◽  
Carmon Koenigsknecht ◽  
Justin Helman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Umbilical Cord ◽  
Oxygen Delivery ◽  
Perinatal Asphyxia ◽  
Neonatal Resuscitation ◽  
Spontaneous Circulation ◽  
Chest Compressions ◽  
Pulmonary Flow ◽  
Current Guidelines ◽  
The Brain

The current guidelines recommend the use of 100% O2 during resuscitation of a neonate requiring chest compressions (CC). Studies comparing 21% and 100% O2 during CC were conducted in postnatal models and have not shown a difference in incidence or timing of return of spontaneous circulation (ROSC). The objective of this study is to evaluate systemic oxygenation and oxygen delivery to the brain during CC in an ovine model of perinatal asphyxial arrest induced by umbilical cord occlusion. Pulseless cardiac arrest was induced by umbilical cord occlusion in 22 lambs. After 5 min of asystole, lambs were resuscitated with 21% O2 as per Neonatal Resuscitation Program (NRP) guidelines. At the onset of CC, inspired O2 was either increased to 100% O2 (n = 25) or continued at 21% (n = 9). Lambs were ventilated for 30 min post ROSC and FiO2 was gradually titrated to achieve preductal SpO2 of 85–95%. All lambs achieved ROSC. During CC, PaO2 was 21.6 ± 1.6 mm Hg with 21% and 23.9 ± 6.8 mm Hg with 100% O2 (p = 0.16). Carotid flow was significantly lower during CC (1.2 ± 1.6 mL/kg/min in 21% and 3.2 ± 3.4 mL/kg/min in 100% oxygen) compared to baseline fetal levels (27 ± 9 mL/kg/min). Oxygen delivery to the brain was 0.05 ± 0.06 mL/kg/min in the 21% group and 0.11 ± 0.09 mL/kg/min in the 100% group and was significantly lower than fetal levels (2.1 ± 0.3 mL/kg/min). Immediately after ROSC, lambs ventilated with 100% O2 had higher PaO2 and pulmonary flow. It was concluded that carotid blood flow, systemic PaO2, and oxygen delivery to the brain are very low during chest compressions for cardiac arrest irrespective of 21% or 100% inspired oxygen use during resuscitation.

scholarly journals Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials

Neurology ◽  
2018 ◽  
Vol 91 (2) ◽  
pp. e123-e131 ◽  
Author(s):  
Rebecca Ichord ◽  
Faye S. Silverstein ◽  
Beth S. Slomine ◽  
Russell Telford ◽  
James Christensen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Wide Spectrum ◽  
Pearson Correlation ◽  
Vineland Adaptive Behavior Scales ◽  
Link Type ◽  
Neurologic Outcomes ◽  
Pediatric Resuscitation ◽  
Poor Outcomes ◽  
Neurobehavioral Outcome

ObjectiveTo implement a standardized approach to characterize neurologic outcomes among 12-month survivors in the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials.MethodsTwo multicenter trials enrolled children age 48 hours to 18 years who remained comatose after cardiac arrest (CA) occurring out-of-hospital (THAPCA-OH, NCT00878644) or in-hospital (THAPCA-IH, NCT00880087); patients were randomized to therapeutic hypothermia or therapeutic normothermia. The primary outcome, survival with favorable 12-month neurobehavioral outcome (Vineland Adaptive Behavior Scales [VABS-II]), did not differ between treatment groups in either trial. Neurologists examined 181 12-month survivors, described findings using the novel semi-quantitative Pediatric Resuscitation after Cardiac Arrest (PRCA) form, and rated findings in 6 domains; scores ranged from 0 (no deficits) to 21 (maximal deficits). PRCA scores were compared with 12-month VABS-II scores and cognitive scores.ResultsNeurologic outcome PRCA scores were classified as no/minimal impairment, PRCA 0–3, 81/179 (45%); mild impairment, PRCA 4–7, 24/179 (13%); moderate impairment, PRCA 8–11, 15/179 (8%); severe impairment, PRCA 12–16, 20/179 (11%); profound impairment, PRCA 17–21, 39/179 (21%) (2/181 incomplete). VABS-II scores correlated strongly with PRCA category (r = −0.88, p < 0.0001, Pearson correlation coefficient) and cognitive scores (r = −0.72, p < 0.0001). Factors associated with poor outcomes included out-of-hospital CA, seizure recognition in the early postarrest period, and poor neurologic status at hospital discharge.ConclusionThe PRCA provides a robust method for depicting neurologic outcomes after acute encephalopathy caused by CA in children. It provides a global semiquantitative rating of neurologic impairment and domain-specific impairment. The strong correlation with well-established neurobehavioral outcome measures supports its validity over a broad age range and wide spectrum of outcomes.

Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow

2004 ◽  
Vol 23 (10) ◽  
pp. 503-505 ◽  
Author(s):  
Frédéric Marrache ◽  
Bruno Megarbane ◽  
Stéphane Pirnay ◽  
Abdel Rhaoui ◽  
Marie Thuong
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Brain Death ◽  
Intracranial Hypertension ◽  
Multiorgan Failure ◽  
Deep Coma ◽  
Ventricular Drainage ◽  
Eeg Activity ◽  
Anoxic Injury

Assessing brain death may sometimes be difficult, with isoelectric EEG following psychotrope overdoses or normal cerebral blood flow (CBF) persisting despite brain death in the case of ventricular drainage or craniotomy. A 42-year-old man, resuscitated after cardiac arrest following a suicidal ingestion of ethanol, bromazepam and zopiclone, was admitted in deep coma. On day 4, his brainstem reflexes and EEG activity disappeared. On day 5, his serum bromazepam concentration was 817 ng/ml (therapeutic: 80-150). The patient was unresponsive to 1 mg of flumazenil. MRI showed diffuse cerebral swelling. CBF assessed by angiography and Doppler remained normal and EEG isoelectric until he died on day 8 with multiorgan failure. There was a discrepancy between the clinically and EEG-assessed brain death, and CBF persistence. We hypothesized that brain death, resulting from diffuse anoxic injury, may lead, in the absence of major intracranial hypertension, to angiographic misdiagnoses. Therefore, EEG remains useful to assess diagnosis in such unusual cases.

Association of post-resuscitation inflammatory response with favorable neurologic outcomes in adults with in-hospital cardiac arrest

Resuscitation ◽  
2021 ◽  
Vol 159 ◽  
pp. 54-59
Author(s):  
Jignesh K. Patel ◽  
Niraj Sinha ◽  
Wei Hou ◽  
Rian Shah ◽  
Asem Qadeer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Inflammatory Response ◽  
Neurologic Outcomes ◽  
Hospital Cardiac Arrest

Abstract 273: Noninvasive Mitochondrial Modulation: Neuroprotection in a Translational Model of Cardiac Arrest and Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Joseph M Wider ◽  
Erin Gruley ◽  
Jennifer Mathieu ◽  
Emma Murphy ◽  
Rachel Mount ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Near Infrared ◽  
Small Animal ◽  
Spontaneous Circulation ◽  
Infrared Light ◽  
Swine Model ◽  
Treatment Groups ◽  
The Brain ◽  
Neuroprotective Therapies

Background: Mitochondrial dysfunction contributes to cardiac arrest induced brain injury and has been a target for neuroprotective therapies. An emerging concept suggests that hyperactivation of neuronal mitochondria following resuscitation results in hyperpolarization of the mitochondrial membrane during reperfusion, which drives generation of excess reactive oxygen species. Previous studies from our group demonstrated that limiting mitochondrial hyperactivity by non-invasively modulating mitochondrial function with specific near infrared light (NIR) wavelengths can reduce brain injury in small animal models of global and focal ischemia. Hypothesis: Inhibitory wavelengths of NIR will reduce neuronal injury and improve neurocognitive outcome in a clinically relevant swine model of cardiac arrest. Methods: Twenty-eight male and female adult swine were enrolled (3 groups: Sham, CA/CPR, and CA/CPR + NIR). Cardiac arrest (8 minutes) was induced with a ventricular pacing wire and followed by manual CPR with defibrillation and epinephrine every 30 seconds until return of spontaneous circulation (ROSC), 2 of the 20 swine that underwent CA did not achieve ROSC and were not enrolled. Treatment groups were randomized prior to arrest and blinded to the CPR team. Treatment was applied at onset of ROSC by irradiating the scalp with 750 nm and 950 nm LEDs (5W) for 2 hours. Results: Sham-operated animals all survived (8/8), whereas 22% of untreated animals subjected to cardiac arrest died within 45 min of ROSC (CA/CPR, n= 7/9). All swine treated with NIR survived the duration of the study (CA/CPR + NIR, n=9/9). Four days following cardiac arrest, neurological deficit score was improved in the NIR treatment group (50 ± 21 CA/CPR vs. 0.8 ± 0.8 CA/CPR + NIR, p < 0.05). Additionally, neuronal death in the CA1/CA3 regions of the hippocampus, assessed by counting surviving neurons with stereology, was attenuated by treatment with NIR (17917 ± 5534 neurons/mm 3 CA/CPR vs. 44655 ± 5637 neurons/mm 3 CA/CPR + NIR, p < 0.05). All data is reported as mean ± SEM. Conclusions: These data provide evidence that noninvasive modulation of mitochondria, achieved by transcranial irradiation of the brain with NIR, mitigates post-cardiac arrest brain injury.

Abstract 17847: Gasping is a Valid Predictor Of ROSC and Hospital Discharge for In-hospital Cardiac Arrest Occurring on the Ward

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Luca Marengo ◽  
Wolfgang Ummenhofer ◽  
Gerster Pascal ◽  
Falko Harm ◽  
Marc Lüthy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Survival Data ◽  
Neurological Outcome ◽  
Rapid Response Team ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Data Set ◽  
Hospital Cardiac Arrest

Introduction: Agonal respiration has been shown to be commonly associated with witnessed events, ventricular fibrillation, and increased survival during out-of-hospital cardiac arrest. There is little information on incidence of gasping for in-hospital cardiac arrest (IHCA). Our “Rapid Response Team” (RRT) missions were monitored between December 2010 and March 2015, and the prevalence of gasping and survival data for IHCA were investigated. Methods: A standardized extended in-hospital Utstein data set of all RRT-interventions occurring at the University Hospital Basel, Switzerland, from December 13, 2010 until March 31, 2015 was consecutively collected and recorded in Microsoft Excel (Microsoft Corp., USA). Data were analyzed using IBM SPSS Statistics 22.0 (IBM Corp., USA), and are presented as descriptive statistics. Results: The RRT was activated for 636 patients, with 459 having a life-threatening status (72%; 33 missing). 270 patients (59%) suffered IHCA. Ventricular fibrillation or pulseless ventricular tachycardia occurred in 42 patients (16% of CA) and were associated with improved return of spontaneous circulation (ROSC) (36 (97%) vs. 143 (67%; p<0.001)), hospital discharge (25 (68%) vs. 48 (23%; p<0.001)), and discharge with good neurological outcome (Cerebral Performance Categories of 1 or 2 (CPC) (21 (55%) vs. 41 (19%; p<0.001)). Gasping was seen in 128 patients (57% of CA; 46 missing) and was associated with an overall improved ROSC (99 (78%) vs. 55 (59%; p=0.003)). In CAs occurring on the ward (154, 57% of all CAs), gasping was associated with a higher proportion of shockable rhythms (11 (16%) vs. 2 (3%; p=0.019)), improved ROSC (62 (90%) vs. 34 (55%; p<0.001)), and hospital discharge (21 (32%) vs. 7 (11%; p=0.006)). Gasping was not associated with neurological outcome. Conclusions: Gasping was frequently observed accompanying IHCA. The faster in-hospital patient access is probably the reason for the higher prevalence compared to the prehospital setting. For CA on the ward without continuous monitoring, gasping correlates with increased shockable rhythms, ROSC, and hospital discharge.

Impact of Sex on Survival and Neurologic Outcomes in Adults With In-Hospital Cardiac Arrest

2020 ◽  
Vol 125 (3) ◽  
pp. 309-312
Author(s):  
Puja B. Parikh ◽  
Aditi Malhotra ◽  
Asem Qadeer ◽  
Jignesh K. Patel
Keyword(s):  
Cardiac Arrest ◽  
Neurologic Outcomes ◽  
Hospital Cardiac Arrest
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