Cardiorespiratory Arrest In Children Research Articles

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.

Out-of-hospital cardiorespiratory arrest in children with trauma

Out-of-hospital cardiorespiratory arrest in children with trauma

Resuscitation of children

Resuscitation of children is rare but something that most GPs dread. It is important that GPs are able to recognise and manage an arrest situation calmly until further help arrives (usually in the form of an ambulance). The most common cause of arrest in children is respiratory failure; this differs from adults where arrest due to cardiac arrhythmia is more common. The outcome from cardio-respiratory arrest in children is poor, particularly if it is a prolonged arrest; therefore early recognition of the deteriorating patient with appropriate intervention is vital.

G43(P) Clinical Audit on Advanced Care Plan For Management of Cardio-Respiratory Arrest in Children and Young Person with Advanced Malignancy (Single Centre Experience)

AimTo find out whether children with advanced malignant disease referred to Palliative care team had advanced care plan for management of cardiopulmonary arrest or not.Secondary objectivesTo detect designated purple form...

Improving cardiopulmonary resuscitation quality with help from a popular song

Pediatric cardiorespiratory arrest (CRA) is a rare event that leads to death or survival with neurological sequelae in many cases. CRA in children usually occurs at home, and therefore the training of paramedics and lay people is essential in order to improve the victim's outcome, regardless of their age. Simple and inexpensive ways of improving bystanders' quality of cardiopulmonary resuscitation should be implemented. We hypothesized that a very popular song, with a rhythm that fits the CPR chest compressions rate target would be an effective audio guidance to train schoolchildren in CPR.

Out-of-hospital cardiorespiratory arrest in children. 8 Years of experience, SAMUR, Madrid

Out-of-hospital cardiorespiratory arrest in children. 8 Years of experience, SAMUR, Madrid

Parada cardiorrespiratoria secundaria a traumatismos en niños. Características y evolución

To analyze the characteristics and outcome of cardiorespiratory arrest secondary to trauma in children. We performed a secondary analysis of data from a prospective, multicenter study of cardiorespiratory arrest in children. Data were recorded according to the Utstein style. Twenty-eight children (age range: 7 days to 16 years) with cardiorespiratory arrest secondary to trauma were evaluated. The outcome variables were return of spontaneous circulation, sustained (more than 20 minutes) return of spontaneous circulation (initial survival), and survival at hospital discharge (final survival) in relation to the characteristics of the cardiorespiratory arrest and cardiopulmonary resuscitation. Neurological and general performance outcome was assessed by means of the Pediatric Cerebral Performance Category scale and the Pediatric Overall Performance Category scale. Return of spontaneous circulation was obtained in 18 patients (64.2 %), initial survival was achieved in 14 (50 %) and final survival was achieved in three (10.7 %) (two without neurological sequelae and one with vegetative status). Final survival was significantly higher in patients with respiratory arrest (33.3 %) than in those with cardiac arrest (4.5 %), p = 0.04. Final survival was also higher in patients with a duration of cardiopulmonary resuscitation shorter than 20 minutes (27.2 %) than in the remaining patients (0 %), p =0.05. The two survivors without neurologic sequelae had respiratory arrest. Survival until hospital discharge in children with cardiorespiratory arrest secondary to trauma is lower than that in children with cardiorespiratory arrest. Patients with respiratory arrest when resuscitation is started and those with a duration of cardiopulmonary resuscitation of less than 20 minutes showed better survival than the remaining patients.

Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain

To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU). Secondary analysis of data from an 18-month prospective, multicentre study analysing cardiorespiratory arrest in children in 16 paediatric intensive care units in Spain. We studied 116 children between 7 days and 17 years of age. Data were recorded according to the Utstein style. Analysed outcome variables were sustained return of spontaneous circulation (ROSC), survival to hospital discharge and survival at 1 year. Neurological and general performance outcome was assessed by means of the Paediatric Cerebral Performance Category (PCPC) and the Paediatric Overall Performance Category (POPC) scales. None. In 80 patients (69%) ROSC was achieved and it was sustained > 20 min in 69 (59.5%). At one-year follow-up, 40 children (34.5%) were alive. Survival was not associated with sex, age or weight of patients. Mortality from cardiac arrest was higher than respiratory arrest (69.8% versus 40%, p = 0.01). Patients with sepsis had a higher mortality than other diagnostic groups. Mechanically ventilated children and those treated with vasoactive drugs had a higher mortality. Initial mortality was slightly higher in patients with slow ECG rhythms (35.7%) compared to those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (27.2%). Duration of resuscitation effort was correlated with mortality (p < 0.0001). Patients who required one or more doses of adrenaline had also a higher mortality (77.8% versus 20.7%, p < 0.0001) and survivors needed less doses of adrenaline (0.85 +/- 1.14 versus 4.4+/-2.9, p < 0.0001). At hospital discharge 86.8 and 84.6% of patients had scores 1 or 2 (normal or near-normal) in the PCPC and POPC scales. At 1-year follow-up these figures were 90.8 and 86.3%, respectively. One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.

Conceptos y prevención de la parada cardiorrespiratoria en niños

In cardiopulmonary resuscitation ages are divided in neonates (in the inmediate period after the birth), infant (from birth to 12 months) and child (from 12 months to puberty). Respiratory arrest is defined by the absence of spontaneous respiration (apnea) or a severe respiratory insufficiency (agonal gasping) that require respiratory assistance. Cardiac arrest is defined as the absence of central arterial pulse or signs of circulation (movement, cough or normal breathing) or the presence of a central pulse less than 60 lpm in a child who does not respond, not breath and with poor perfusion. After resuscitation the return of spontaneous circulation is defined as the recuperation of central arterial pulse or signs of circulation in a child with previous cardiorespiratory arrest. It is maintained when the duration is longer than 20 minutes. Injuries, sudden infant death syndrome, and respiratory diseases are the most frequent etiologies of cardiorrespiratory arrest in children. The prevention and the formation of citizens in basic cardiopulmonary resuscitation are the most effective measures to reduce the mortality of cardiorespiratory arrest in children.

Outcome of Out-of-Hospital Cardiorespiratory Arrest in Children

To analyze the characteristics and outcome of out-of-hospital cardiorespiratory arrest in children in Spain. Secondary analysis of data from a prospective, multicenter study analyzing cardiorespiratory arrest in children. Ninety-five children between 7 days and 16 years with cardiorespiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Neurologic and general performance outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale and the Pediatric Overall Performance Category (POPC) scale. Initial survival was 47.3% and 1-year survival was 26.4%. Mortality was higher in children younger than 1 year. Survival of patients with respiratory arrest (82.1%) was significantly higher than survival of cardiac arrest victims (14.4%). Patients who were initially resuscitated by laypersons or paramedics had higher survival (53.6%) than those who were initially resuscitated by doctors and/or nurses (15.2%) (P < 0.01). Mortality was higher in the patients who presented slow rhythms (asystole, severe bradycardia) or pulseless electrical activity than in those presenting ventricular fibrillation (P = 0.001). Multivariate logistic regression revealed that the best indicator of mortality was duration of cardiopulmonary resuscitation longer than 20 minutes. After 1 year, most survivors had normal or mild disability. Mortality of out-of-hospital cardiorespiratory arrest in children is high. When resuscitation is started soon by layperson or paramedics, survival is increased. Duration of resuscitation efforts is the best indicator of mortality. Most of survivors had good long-term neurologic outcome.

¿Están justificadas las dosis elevadas de adrenalina en la parada cardiorrespiratoria en niños?

To evaluate the impact on survival of intravenous or intraosseous high-dose epinephrine compared with standard doses in children with cardiorespiratory arrest. We performed a multicenter, prospective study. Cardiopulmonary resuscitation data from 283 children was collected following international guidelines (Utstein style) over 18 months. In a secondary analysis we studied survival in 92 children who were treated with intravenous or intraosseous epinephrine. One or more conventional doses of epinephrine (0.01 mg/kg) were administered in 12 patients and a first conventional dose followed by one or more high doses (0.1 mg/kg) were administered in 80 patients. The age and weight of children in the conventional-dose group were higher than those in the high-dose group (97.1 +/- 70.5 months vs 29.9 +/- 36.9 months, p = 0.03 and 24.7 +/- 20.8 kg vs 11.9 +/- 8.9 kg, p = 0.037, respectively). The number of doses administered in the conventional-dose group was lower than that in the high-dose group (4 +/- 4 vs 5.4 +/- 3.4, p = 0.01). No significant differences were observed between the two groups in type of arrest, site of arrest, initial electrocardiographic rhythm, response to resuscitation attempts with return of spontaneous circulation, total resuscitation time, neurological status at the end of the episode and survival to hospital discharge and at 1-year of follow-up. Although the present study has considerable limitations, the results suggest that high doses of epinephrine do not improve survival in cardiorespiratory arrest in children.

Long-term outcome of paediatric cardiorespiratory arrest in Spain

To analyse the final outcome of cardiorespiratory arrest (CRA) in children and the neurological and functional state of survivors at 1 year. An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital CRA in children was carried out; 283 children between 7 days and 17 years of age were included. CRA and resuscitation data were registered according to Utstein style. The outcome variables were: sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). The status of survivors was evaluated by means of the paediatric cerebral performance category (PCPC) scale and the paediatric overall performance category (POPC) scale at Paediatric Intensive Care Unit discharge, at hospital discharge, and at 1 year follow-up. In 283 children, 311 CRA episodes, 73 respiratory arrests (23.5%) and 238 cardiac arrests (76.5%) were analysed. Seventeen children suffered more than one CRA episode (range: 2-6). The initial survival was 60.2% and 1-year survival was 33.2%. The final survival was significantly higher in respiratory arrest than in cardiac arrest patients (70.0% versus 21.1%) (P < 0.0001). After 1 year follow-up, 87.3% of patients had scores 1 or 2 on the PCPC scale and 84.0% had scores 1 or 2 in the POPC scale; these results indicate that 1 year after CRA, the majority of survivors had normal neurological and functional status or showed only mild disability. Prognosis of CRA in children continues to be poor in terms of survival but quite good in terms of neurological and functional status among survivors. Additional strategies and efforts are needed to improve the short-term prognosis of paediatric CRA. However, the long-term outcome of survivors is reassuring.

Characteristics and outcome of cardiorespiratory arrest in children

To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain. An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital cardio-respiratory arrest in children. Two hundred and eighty-three children between 7 days and 17 years of age with cardio-respiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Three hundred and eleven cardio-respiratory arrest episodes, composed of 70 respiratory arrests and 241 cardiac arrests in 283 children were studied. Accidents were the most frequent cause of out-of-hospital arrest (40%), and cardiac disease was the leading cause (31%) of in-hospital arrest. Initial survival was 60.2% and 1 year survival was 33.2%. The final survival was higher in patients with respiratory arrest (70%) than in patients with cardiac arrest (21.1%) (P <0.0001). Although many individual factors correlated with mortality, multivariate logistic regression revealed that the best indicator of mortality was a duration of cardiopulmonary resuscitation of over 20 min (odds ratio: 10.35; 95% CI 4.59-23.32). In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.

Reconocimiento del niño con riesgo de parada cardiorrespiratoria

Cardiorespiratory arrest in children with severe disease does not usually present suddenly or unexpectedly but is often the result of a progressive deterioration of respiratory and/or circulatory function. Before failure of these functions occurs, there is a series of clinical signs that serve as a warning. Health professionals should not only evaluate clinical signs of respiratory and/or circulatory insufficiency but should also be able to identify these warning signs as early as possible, preferably in the compensation phase, given that the possibility that this process can be reversed by therapeutic measures decreases as the process progresses.

Anoxic cardiopulmonary arrest in a pediatric animal model

We studied the response to anoxia in young dogs in order to provide some clinical and laboratory guidelines with which to gauge duration of respiratory and cardiorespiratory arrest in children. Immediately following the onset of anoxia, the animals developed hypertension. After a mean period of 279.5 seconds (range, 224 to 325 sec), they became asystolic. Following an observation period of five minutes after the onset of asystole, pH declined to a mean of 7.01 and PO2 declined to 7.1 torr, while PCO2 rose to 92.1 torr. We concluded that asystole occurs after a relatively brief period of anoxia during a time interval when the brain retains the potential for full recovery. While no single factor clearly indicates a very prolonged arrest, a pH below 6.9 which does not rise with the institution of adequate ventilation suggests anoxia of greater than five minutes' duration.