Arrest In Children Research Articles

Giant Left Atrial Appendage Aneurysm or Pericardial Effusion: A Misleading Appearance on Echocardiography and a High Risk of Rupture

Left atrial appendage (LAA) aneurysm or giant LAA is an uncommon condition. It could be discovered incidentally during echocardiography examination or in symptomatic patients presenting with tachycardia or embolic events. The giant LAA is a serious condition with a high embolic risk that can cause respiratory distress and even cardiac arrest in children. A conservative surgical approach based on resection of the LAA is recommended and is mostly safe. We report the case of a four-year-old girl presenting with a symptomatic giant LAA removed successfully. The echo-cardiographer must be aware of its appearance mimicking a pericardial effusion and focus on its possible association with other congenital lesions. There are several therapeutic strategies, all with proven efficacy and safety.

United States Youth Arrest and Health Across the Life Course: A Nationally Representative Longitudinal Study.

Youth are arrested at high rates in the United States; however, long-term health effects of arrest remain unmeasured. We sought to describe the sociodemographic characteristics and health of adults who were arrested at various ages among a nationally representative sample. Using the National Longitudinal Study of Adolescent to Adult Health, we describe sociodemographics and health status in adolescence (Wave I, ages 12-21) and adulthood (Wave V, ages 32-42) for people first arrested at age younger than 14 years, 14 to 17 years, and 18 to 24 years, compared to never arrested adults. Health measures included physical health (general health, mobility/functional limitations, death), mental health (depressive symptoms, suicidal thoughts), and clinical biomarkers (hypertension, diabetes). We estimate associations between age of first arrest and health using covariate adjusted regressions. Among the sample of 10,641 adults, 28.5% had experienced arrest before age 25. Individuals first arrested as children (ie, age <14) were disproportionately Black, compared to White. Compared to individuals never arrested, people arrested before age 25 had more depressive symptoms and higher rates of suicidal thoughts during adolescence. Arrest before age 25 was associated with worse self-reported health, higher rates of functional limitations, more depressive symptoms, and greater mortality by adulthood (ages 32-42). Arrest before age 25 was associated with worse physical and mental health--and even death in adulthood. Child arrest was disproportionately experienced by Black children. Reducing arrests of youth may be associated with improved health across the life course, particularly among Black youth, thereby promoting health equity.

Predicting Cardiac Arrest in Children with Heart Disease: A Novel Machine Learning Algorithm

Children with congenital and acquired heart disease are at a higher risk of cardiac arrest compared to those without heart disease. Although the monitoring of cardiopulmonary resuscitation quality and extracorporeal resuscitation technologies have advanced, survival after cardiac arrest in this population has not improved. Cardiac arrest prevention, using predictive algorithms with machine learning, has the potential to reduce cardiac arrest rates. However, few studies have evaluated the use of these algorithms in predicting cardiac arrest in children with heart disease. We collected demographic, laboratory, and vital sign information from the electronic health records (EHR) of all the patients that were admitted to a single-center pediatric cardiac intensive care unit (CICU), between 2010 and 2019, who had a cardiac arrest during their CICU admission, as well as a comparator group of randomly selected non-cardiac-arrest controls. We compared traditional logistic regression modeling against a novel adaptation of a machine learning algorithm (functional gradient boosting), using time series data to predict the risk of cardiac arrest. A total of 160 unique cardiac arrest events were matched to non-cardiac-arrest time periods. Using 11 different variables (vital signs and laboratory values) from the EHR, our algorithm's peak performance for the prediction of cardiac arrest was at one hour prior to the cardiac arrest (AUROC of 0.85 [0.79,0.90]), a performance that was similar to our previously published multivariable logistic regression model. Our novel machine learning predictive algorithm, which was developed using retrospective data that were collected from the EHR and predicted cardiac arrest in the children that were admitted to a single-center pediatric cardiac intensive care unit, demonstrated a performance that was similar to that of a traditional logistic regression model. While these results are encouraging, future research, including prospective validations with multicenter data, is warranted prior to the implementation of this algorithm as a real-time clinical decision support tool.

Impact of Quality Improvement Bundle on Compliance with Resuscitation Guidelines during In-Hospital Cardiac Arrest in Children.

Various quality improvement (QI) interventions have been individually assessed for the quality of cardiopulmonary resuscitation (CPR). We aimed to assess the QI bundle (hands-on training and debriefing) for the quality of CPR in our children's hospital. We hypothesized that the QI bundle improves the quality of CPR in hospitalized children. We initiated a QI bundle (hands-on training and debriefing) in August 2017. We conducted a before-after analysis comparing the CPR quality during July 2013-May 2017 (before) and January 2018-December 2020 (after). We collected data from the critical events logbook on CPR duration, chest compressions (CC) rate, ventilation rate (VR), the timing of first dose of epinephrine, blood pressure (BP), end-tidal CO2 (EtCO2), and vital signs monitoring during CPR. We performed univariate analysis and presented data as the median interquartile range (IQR) and in percentage as appropriate. We compared data from 58 CPR events versus 41 CPR events before and after QI bundle implementation, respectively. The median (IQR) CPR duration for the pre- and post-QI bundle was 5 (1-13) minutes and 3 minutes (1.25-10), and the timing of the first dose of epinephrine was 2 (1-2) minutes and 2 minutes (1-5), respectively. We observed an improvement in compliance with the CC rate (100-120 per minute) from 72% events before versus 100% events after QI bundle implementation (p=0.0009). Similarly, there was a decrease in CC interruptions and hyperventilation rates from 100% to 50% (p=0.016) and 100% vs. 63% (p=<0.0001) events before vs. after QI bundle implementation, respectively. We also observed improvement in BP monitoring from 36% before versus 60% after QI bundle (p=0.014). Our QI bundle (hands-on training and debriefing) was associated with improved compliance with high-quality CPR in children.

Out-of-hospital cardiac arrest in children

Out-of-hospital cardiac arrest in children

Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children

AimOut-of-hospital cardiac arrest (OHCA) in pediatric patients is associated with high rates of mortality and neurologic injury, with no definitive evidence-based method to predict outcomes available. A prognostic scoring tool for adults, The Brain Death After Cardiac Arrest (BDCA) score, was recently developed and validated. We aimed to validate this score in pediatric patients. MethodsRetrospective cohort study of pediatric patients admitted to 5 PICUs after OHCA between 2011 and 2021. We extracted BDCA score elements for those who survived at least 24 hours but died as a result of their OHCA. We assessed score discrimination for the definitive outcome of brain death. Subgroup analysis was performed for infants < 12mo versus children ≥ 12mo, those who likely had brain death but had withdrawal of life sustaining therapy (WLST) prior to declaration, and by etiology and duration of arrest. Results389 subjects were identified across 5 institutions, with 282 meeting inclusion criteria. 169 (59.9%) were formally declared brain dead; 58 (20.6%) had findings consistent with brain death but had withdrawal of life sustaining therapies prior to completion of formal declaration. Area under the receiver operating characteristic curve for the age ≥ 12mo cohort was 0.82 [95% CI 0.75, 0.90], which mirrored the adult subject AUCs of 0.82 [0.77, 0.86] and 0.81 [0.76, 0.86] in the development and validation cohorts. Scores demonstrated worse discrimination in the infant cohort (AUC = 0.61). ConclusionsThe BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.

Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression.

The incidence of out-of-hospital cardiac arrest (OHCA) and its mortality among children decreased globally over the years. However, the incidence, mortality, and its determinants are heterogeneous globally. The current study was designed to investigate the incidence of OHCA, mortality, and its determinants based on a systematic review of published literature. A comprehensive search was conducted in PubMed/Medline; Science Direct, Cochrane Library, Hinari, and LILACS without language and date restrictions. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. A total of 2526 articles were identified from different databases with an initial search. Forty-eight articles with 138.3 million participants were included in the systematic review. The meta-analysis showed that the pooled rate of mortality was found to be 70% (95% CI: 57-81%, 42 studies, 28,345 participants). The incidence of OHCA and mortality among children was very high among children with significant regional disparity. Those children with cardiovascular causes of arrest, and initial nonshockable rhythm were independent predictors of OHCA-related mortality. This systematic review and meta-analysis is registered in Prospero (CRD42022316602). IMPACT: This systematic review addresses a significant health problem in a global context from 1995 to 2022. The meta-regression revealed that the incidence of OHCA and mortality of children decline over the years in high-income countries despite regional dispraises among individual studies. Body of evidence on the incidence of OHCA and mortality is lacking in low- and middle-income countries.

Factors associated with survival and neurologic outcome after in-hospital cardiac arrest in children: A cohort study

AimIn-hospital paediatric cardiopulmonary resuscitation (CPR) survival has been improving in high-income countries. This study aimed to analyse factors associated with survival and neurological outcome after paediatric CPR in a middle-income country. MethodsThis observational study of in-hospital cardiac arrest using Utstein-style registry included patients <18 years old submitted to CPR between 2015 and 2020, at a high-complexity hospital. Outcomes were survival and neurological status assessed using Paediatric Cerebral Performance Categories score at prearrest, discharge, and after 180 days. ResultsOf 323 patients who underwent CPR, 108 (33.4%) survived to discharge and 93 (28.8%) after 180 days. In multivariable analysis, lower survival at discharge was associated with liver disease (OR 0.060, CI 0.007–0.510, p = 0.010); vasoactive drug infusion before cardiac arrest (OR 0.145, CI 0.065–0.325, p < 0.001); shock as the immediate cause (OR 0.183, CI 0.069–0.486, p = 0.001); resuscitation > 30 min (OR 0.070, CI 0.014–0.344, p = 0.001); and bicarbonate administration during CPR (OR 0.318, CI 0.130–0.780, p = 0.01). The same factors remained associated with lower survival after 180 days. Neurological outcome was analysed in the 93 survivors after 180 days following CPR. Prearrest neurological dysfunction was observed in 31.4%, and neurological prognosis was favourable in 79.7% at discharge and similar after 180 days. ConclusionIn-hospital paediatric cardiac arrest patients with complex chronic conditions had lower survival associated with liver disease, shock as cause of cardiac arrest, vasoactive drug infusion before cardiac arrest, bicarbonate administration during CPR, and prolonged resuscitation. Most survivors had favourable neurological outcome.

Risk factors for early acute kidney injury after cardiac arrest in children in the pediatric intensive care unit and a prognostic analysis

To investigate the risk factors for acute kidney injury (AKI) in children with cardiac arrest (CA) and the influencing factors for prognosis. A retrospective analysis was performed on the medical records of the children who developed CA in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from June 2016 to June 2021. According to the presence or absence of AKI within 48 hours after return of spontaneous circulation (ROSC) for CA, the children were divided into two groups: AKI (n=50) and non-AKI (n=113). According to their prognosis on day 7 after ROSC, the AKI group was further divided into a survival group (n=21) and a death group (n=29). The multivariate logistic regression analysis was used to investigate the risk factors for early AKI in the children with CA and the influencing factors for prognosis. The incidence rate of AKI after CA was 30.7% (50/163). The AKI group had a 7-day mortality rate of 58.0% (29/50) and a 28-day mortality rate of 78.0% (39/50), and the non-AKI group had a 7-day mortality rate of 31.9% (36/113) and a 28-day mortality rate of 58.4% (66/113). The multivariate logistic regression analysis showed that long duration of cardiopulmonary resuscitation (OR=1.164, 95%CI: 1.088-1.246, P<0.001), low baseline albumin (OR=0.879, 95%CI: 0.806-0.958, P=0.003), and adrenaline administration before CA (OR=2.791, 95%CI: 1.119-6.961, P=0.028) were closely associated with the development of AKI after CA, and that low baseline pediatric critical illness score (OR=0.761, 95%CI: 0.612-0.945, P=0.014), adrenaline administration before CA (OR=7.018, 95%CI: 1.196-41.188, P=0.031), and mechanical ventilation before CA (OR=7.875, 95%CI: 1.358-45.672, P=0.021) were closely associated with the death of the children with AKI after CA. Albumin should be closely monitored for children with ROSC after CA, especially for those with long duration of cardiopulmonary resuscitation, low baseline pediatric critical illness score, adrenaline administration before CA, and mechanical ventilation before CA, and such children should be identified and intervened as early as possible to reduce the incidence of AKI and the mortality rate.

Abstract 15047: Survival With Favorable Neurological Outcome and Quality of CPR Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared to Non-Cardiac Disease

Introduction: Children with cardiac disease have higher rates of in hospital cardiac arrest (IHCA) compared to non-cardiac disease. We aimed to determine differences in survival in children with medical and surgical cardiac compared to non-cardiac disease following IHCA and to assess whether CPR quality was different between groups. Hypothesis: We hypothesized: 1) medical cardiac have worse and surgical cardiac have improved outcomes compared to non-cardiac patients, and 2) CPR quality is similar between groups. Methods: A secondary analysis of the ICU-RESUS citation project ( ICU-RESUS ; NCT02837497) was conducted. The primary outcome was survival to hospital discharge with favorable neurological outcome defined as a Pediatric Cerebral Performance Category score of 1 - 3 or no change from baseline. Secondary outcomes included physiologic measures of intra-arrest quality. Results: Of 1100 children with IHCA, 273 (25%) were medical cardiac, 383 (35%) were surgical cardiac, and 444 (40%) were non-cardiac. The medical cardiac group was less likely to survive with favorable outcome compared to the non-cardiac group (48% vs. 55%, aOR 0.59, CI 95 0.40, 0.88). There was no difference in outcome between the surgical cardiac (58%) and non-cardiac group. There were no differences in chest compression (CC) rate, CC fraction, ventilation rate, intra-arrest average target diastolic blood pressure or average target systolic blood pressure between medical cardiac vs. non-cardiac and surgical cardiac vs. non-cardiac groups. The surgical cardiac group was less likely to achieve target CC depth compared to non-cardiac group (OR 0.15, CI 95 0.02, 0.52). There was no difference in CC depth in medical cardiac vs. non-cardiac groups. Conclusions: In this large study of pediatric IHCA, medical cardiac patients had lower survival with favorable neurologic outcome compared to non-cardiac patients. Surgical cardiac patients had similar outcome to non-cardiac patients. CPR quality was similar in medical-cardiac and non-cardiac patients, however delivered CC depths were lower in surgical cardiac compared to non-cardiac patients.

Abstract 273: Epinephrine Dose Distribution And Impact On Survival After Extracorporeal Cardiopulmonary Resuscitation In Children

Background: Although AHA guidelines recommend a fixed epinephrine (epi) dosing frequency during cardiac arrest, it is unknown if a fixed dosing practice is both utilized and effective for EPCR events in children. We hypothesized that 1) epi dosing would not be uniformly distributed during ECPR events and 2) a strategy of limiting epi doses during ECPR would be associated with better survival to hospital discharge (SHD). Methods: This was a multicenter retrospective cohort study of ECPR after in-hospital cardiac arrest in children (&lt; 18 years) between 2012 - 2019. Patient and arrest event details as well as epi dose and time-stamps were recorded. In patients with a CPR duration of ≥ 30 minutes, dosing strategies were categorized as either “frequent epi” (FE; average epi dosing interval of ≤ 5 mins/dose during the first 30 mins of CPR) or “limited epi” (LE; average dosing interval of ≤ 5 mins/dose for the first 10 mins followed by &gt; 5 mins/dose through 30 mins). The primary outcome was SHD. Results: A total of 191 patients from 5 centers were included; overall SHD was 43% (82/191). Epi doses were not evenly distributed, with 66% (919/1385) of doses being given during the first half of CPR. Mean number of epi doses was similar between survivors and non-survivors in the first 10 mins (2.7 doses). After 10 mins, survivors received fewer doses than non-survivors per each 10 min interval (Figure). In the subset of patients that received ≥ 30 mins of CPR (n=147) the LE group had higher SHD [48% (14/52) vs. 27% (46/95), p=0.01] and improved odds of SHD after adjusting for age, sex, illness category, time of day, first pulseless rhythm and CPR duration [OR (95% CI) 4.2 (1.5-11.7); p =0.008]. Conclusion: In contrast to AHA guidelines, epi dosing was not evenly distributed during events in this multicenter study of pediatric in-hospital ECPR. For children with CPR duration ≥ 30 minutes a strategy of limiting epi doses was associated with improved SHD.

Abstract 02: Intravenous Oxygen Microparticles as Resuscitative Fluid Improves Outcomes in a Swine Model of Asphyxial Cardiac Arrest

Introduction: Asphyxia-induced cardiac arrest (ACA) can lead to organ damage and death within minutes, with a reported survival rate of 25-38%. It is the leading cause of in-hospital cardiac arrest in children and elderly and the second in adults. The direct injection of oxygen as a rescue therapy for ACA is not yet possible. Methods: We manufactured immediate-release intravenous oxygen (IVO 2 ) microparticles with a shell composed of biocompatible dextran polymers formed by nanoprecipitation. Following intravenous injection, the hydrophobic shell transitions from a crystalline state to a rapidly dissolving, fluid shell based on pH (A). IVO 2 was manufactured following Good Manufacturing Practice control over particle size, chemical purity, and sterility. Following instrumentation, Yorkshire swine (n=10 control, n=6 IVO 2 ) underwent complete asphyxia by endotracheal tube occlusion for 12 minutes (B). ACLS was performed whenever SBP&lt;40 mmHg. At minute 6, 8 and 10 of asphyxia, IVO 2 or placebo (20 mL/kg fluid phase) was administered. Animals were then survived for 4 days in an ICU environment, followed by brain MRI and neurohistology. Results: Animals receiving IVO 2 exhibited increased arterial oxygen saturation during asphyxia (p&lt;0.05, C), with less CPR time (p&lt;0.001, D) and higher ROSC (p=0.011, E). Three out of 6 IVO 2 animals vs 0/3 surviving controls were successfully extubated (p=0.035). IVO 2 treatment was associated with increased survival (p=0.037, F) with improved swine neurologic deficit scores (p&lt;0.05, G). MRI (H) and pathology (I) demonstrated devastating hypoxic-ischemic injury in all surviving controls, endpoints that were significantly improved with IVO 2 . No significant adverse effects were noted in hematologic, coagulation, hepatic, or renal function due to IVO 2 . Conclusion: Treatment of ACA with IVO 2 may diminish critical oxygen deficit, resulting in improved survival and neurological outcomes.

Catecholamine Toxicity After Craniotomy Evacuation Craniotomy and Evacuation of The Abscess

Increasing levels of endogenous catecholamines occur acutely to provide short-time adaptation to stressful conditions, known as the fight-or-fly response. Catecholamine toxicity requires multidisciplinary management. In this case, the patient is diagnosed with a brain abscess since birth. According of the history, physical examination and investigations, it was concluded that the diagnosis of epidural abscess with abscess evacuation craniotomy and PS ASA 2 (leukocytosis) with GA-ETT anesthesia. The operation is carried out with a duration of 4 hours. Vital sign monitoring obtained blood pressure sp108 – 125 62 - 90 mmHg, heart frequency 90 - 120 times per minute, 99% oxygen saturation. When in the recovery room, the patient experiences cardiac arrest, this is thought to result from catecholamine toxicity. Patients are treated as resuscitation in accordance with the algorithm of cardiac arrest in children. Patients experienced a response of spontaneous circulation (ROSC) and performed vital sign monitoring.

Early Changes in Near-Infrared Spectroscopy Are Associated With Cardiac Arrest in Children With Congenital Heart Disease.

BackgroundThe association of near-infrared spectroscopy (NIRS) with various outcomes after pediatric cardiac surgery has been studied extensively. However, the role of NIRS in the prediction of cardiac arrest (CA) in children with heart disease has yet to be evaluated. We sought to determine if a model utilizing regional cerebral oximetry (rSO2c) and somatic oximetry (rSO2s) could predict CA in children admitted to a single-center pediatric cardiac intensive care unit (CICU).MethodsWe retrospectively reviewed 160 index CA events for patients admitted to our pediatric CICU between November 2010 and January 2019. We selected 711 control patients who did not have a cardiac arrest. Hourly data was collected from the electronic health record (EHR). We previously created a machine-learning algorithm to predict the risk of CA using EHR data. Univariable analysis was done on these variables, which we then used to create a multivariable logistic regression model. The outputs from the model were presented by odds ratio (OR) and 95% confidence interval (CI).ResultsWe created a multivariable model to evaluate the association of CA using five variables: arterial saturation (SpO2)- rSO2c difference, SpO2-rSO2s difference, heart rate, diastolic blood pressure, and vasoactive inotrope score. While the SpO2-rSO2c difference was not a significant contributor to the multivariable model, the SpO2-rSO2s difference was. The average SpO2-rSO2s difference cutoff with the best prognostic accuracy for CA was 29% [CI 26–31%]. In the multivariable model, a 10% increase in the SpO2-rSO2s difference was independently associated with increased odds of CA [OR 1.40 (1.18, 1.67), P < 0.001] at 1 h before CA. Our model predicted CA with an AUROC of 0.83 at 1 h before CA.ConclusionIn this single-center case-control study of children admitted to a pediatric CICU, we created a multivariable model utilizing hourly data from the EHR to predict CA. At 1 h before the event, for every 10% increase in the SpO2-rSO2s difference, the odds of cardiac arrest increased by 40%. These findings are important as the field explores ways to capitalize on the wealth of data at our disposal to improve patient care.

Cardiac Arrest in Children Following Cardiac Surgery: A Scoping Review of Contributing Factors.

Nearly half of children experiencing cardiac arrest following cardiac surgery do not survive hospital discharge and patients who survive often experience significant neurological impairment. Additionally, increased resource utilization following cardiac arrest translates into adverse logistical and financial consequences. Although some studies have identified patient characteristics that increase the risk of cardiac arrest after pediatric cardiac surgery, modifiable risk factors, which could provide a foundation for effective prevention strategies, have been elusive. This scoping review explores the current knowledge surrounding risk factors associated with cardiac arrest in children following cardiac surgery and provides recommendations for future research.

A very rare cause of sudden cardiac arrest in children: triadin knockout syndrome.

A 7.5-year-old male patient was referred to our clinic with a history of recurrent syncope and aborted cardiac arrest. There was no family history of sudden death, syncope, or arrhythmia. Physical examination, electrocardiography, echocardiography, and 24-hour rhythm Holter monitoring were normal, and bidirectional ventricular tachycardiaT was detected during the exercise stress test. Genetic analysis revealed a homozygous mutation of c.531_533delinsGG, p.(Lys179Asnfs * 44) frameshift variant in TRDN(NM_006073) gene. A 4.5-year-old male was admitted due to syncope during exertion and underwent cardiopulmonary resuscitation due to sudden cardiac arrest. He had family history about sudden cardiac death. Physical examination was normal, and there was borderline QTc prolongation. Bidirectional non-sustained polymorphic ventricular tachycardia was observed at adrenaline provocation test. In genetic analysis, c.568dupA, pII190Asnfs * 2 frameshift variant homozygous mutation was detected in TRDN(NM_006073) gene. Intracardiac defibrillator implantation were performed for both cases. There has not been any event under propranolol and flecainide combination treatment. Triadin knockout syndrome (TCOS) is a rare overlap syndrome characterized by highly malignant arrhythmias, and it is a deadly combination of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia that affects primarily young children. Since lethal arrhythmias are frequently described, genetic testing is very important in these patients. Because, identification of a genetic mutation may be a guide in treatment.

The Feasibility of Using Point-of-Care Ultrasound During Cardiac Arrest in Children: Rapid Apical Contractility Evaluation.

Resuscitation guidelines emphasize minimal interruption of compressions during cardiopulmonary resuscitation. Point-of-care ultrasound (POCUS) enables the clinician to visualize cardiac contractility and central artery pulsatility. The apical 4-chamber (A4), subxiphoid (SX), and femoral artery views may be used when defibrillator pads or active compressions preclude parasternal cardiac views. We hypothesized that clinicians can rapidly obtain interpretable POCUS views in healthy children from the A4, SX, and femoral positions. A prospective study of pediatric emergency medicine providers in an urban academic hospital was performed. Stable patients of 12 years or younger were scanned. Sonologists were each allotted 10 seconds to acquire A4, SX, and femoral views. Two attempts at each view were allowed. The primary outcome was whether cardiac and femoral artery scans were interpretable for contractility and pulsatility, respectively. The secondary outcome was whether cardiac scans were interpretable for effusion or right ventricular strain. A POCUS expert reviewed scans to confirm interpretability. Twenty-two sonologists performed a total of 50 scans on 22 patients. A view that was interpretable for contractility was obtained on the first attempt in 86% of A4 and 94% of SX scans. A femoral view that was interpretable for pulsatility was obtained on the first attempt in 74% of scans. Expert review was concordant with sonologist interpretation. Pediatric emergency medicine physicians can obtain interpretable cardiac and central artery views within 10 seconds most of the time. Point-of-care ultrasound has the potential to enhance care during pediatric resuscitation. Future studies on the impact of POCUS pulse checks in actual pediatric resuscitations should be performed.

Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review

Background: Therapeutic hypothermia is used in adults and neonates after cardiac arrest, but its efficiency in children under 18 years old is still uncertain. Objective: To evaluate the effectiveness and risks of therapeutic hypothermia after cardiac arrest in children under 18 years of age through a systematic review. Methods: A systematic review was performed in January 2022 in the MEDLINE, SciELO, Cochrane, and LILACS databases. Inclusion criteria: randomized controlled trials (RCTs) performed in humans. Articles from other typologies, published [...]

Case Report of a Cardiac Arrest during Surgery Revealing an Arnold Chiari Malformation

Arnold Chiari malformation is a common congenital anomaly of the craniocervical junction. It is defined as a descent of the cerebellar tonsils below the foramen magnum, putting pressure on both the brain and spine causing many symptoms. The patients typically experience no symptoms or chronic slowly progressive symptoms. However, recent reports indicate that a subset of patients with AC may present with acute deterioration, cardiorespiratory arrest and sudden unexpected death. We report a case of sudden unexpected death of a 34 years old woman, married with 3 kids, without any medical history, that was admitted for a heterogeneous multinodular goiter in clinical and biological euthyroidism and scheduled for total thyroidectomy. In intraoperative, the patient presented a cardiorespiratory arrest while positioning her head in hyperextension for a good surgical approach, neck released by anesthesia. Para-clinical tests showed later an AC malformation. Cases of sudden cardiorespiratory arrest in children and adults with AC malformation have been documented, leading to death in some cases. However, these patients who died unexpectedly have experienced a recent trauma. This is a unique example of a sudden unexpected death of a woman undiagnosed AC, in absence of any previous trauma, that occurred during a conventional anesthesia for a thyroid surgery.

Pediatric In-Hospital Cardiac Arrest International Registry (PACHIN): protocol for a prospective international multicenter register of cardiac arrest in children

Background and aimsCardiac arrest (CA) in children is a major public health problem. Thanks to advances in cardiopulmonary resuscitation (CPR) guidelines and teaching skills, results in children have improved. However, pediatric CA has a very high mortality. In the treatment of in-hospital CA there are still multiple controversies. The objective of this study is to develop a multicenter and international registry of in-hospital pediatric cardiac arrest including the diversity of management in different clinical and social contexts. Participation in this register will enable the evaluation of the diagnosis of CA, CPR and post-resuscitation care and its influence in survival and neurological prognosis.MethodsAn intrahospital CA data recording protocol has been designed following the Utstein model. Database is hosted according to European legislation regarding patient data protection. It is drafted in English and Spanish. Invitation to participate has been sent to Spanish, European and Latinamerican hospitals. Variables included, asses hospital characteristics, the resuscitation team, patient’s demographics and background, CPR, post-resuscitation care, mortality, survival and long-term evolution. Survival at hospital discharge will be evaluated as a primary outcome and survival with good neurological status as a secondary outcome, analyzing the different factors involved in them. The study design is prospective, observational registry of a cohort of pediatric CA.ConclusionsThis study represents the development of a registry of in-hospital CA in childhood. Its development will provide access to CPR data in different hospital settings and will allow the analysis of current controversies in the treatment of pediatric CA and post-resuscitation care. The results may contribute to the development of further international recommendations.Trial register: ClinicalTrials.gov Identifier: NCT04675918. Registered 19 December 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04675918?cond=pediatric+cardiac+arrest&draw=2&rank=10