Pediatric Cardiopulmonary Resuscitation Research Articles

Epidemiology and outcomes of pediatric cardiac arrest in a cardiovascular unit at a public hospital in Argentina.

Children with congenital heart disease present a higher frequency of cardiorespiratory arrest (CRA) than the general pediatric population. The epidemiology of CRA is not exactly known in our setting, nor are the mortality risk or the neurological evolution factors. To describe the epidemiology and outcomes associated with pediatric cardiopulmonary resuscitation in a cardiovascular recovery unit. The primary endpoint was the survival to discharge and the secondary endpoints were the return to spontaneous circulation, the survival at 24 hours and the remote neurological condition. Descriptive, prospective, longitudinal cohort study in children under 18 years of age who required cardiopulmonary resuscitation between 2016 and 2019. Demographic variables, characteristics of cardiopulmonary arrest, resuscitation and outcome were analyzed. An uni- and multivariate analysis was performed comparing survivors and deceased. Out of 1,842 hospitalized patients, 4.1% presented CRA. Fifty patients with complete records were analyzed. Seventy-eight percent (39) returned to spontaneous circulation with a high survival rate of 46%. Resuscitation > 6 min and the use of vasoactive drugs were predictors of mortality; 16/23 patients were followed up, 10 of them with normal development for age at 6 months, six had pervasive developmental disorder. 4.1% of patients presented CRA, with a rate of 3.4 CRA per 1,000 patient-days. Survival at hospital discharge (n = 50) was 46%. Resuscitation > 6 min and the use of vasoactive drugs were independent predictors of mortality. At six months, 63% had normal neurological development for age.

Effectiveness of simulation-based paediatric cardiopulmonary resuscitation training program among nursing students in Saudi Arabia.

The main objective of this study was to adopt a simulation-based advanced cardiac life support training program to assess nursing students' level of knowledge and practice regarding paediatric advanced cardiac life support and to identify the major knowledge and practice gaps. The methods used in this study were pre-experimental, one group pre and post-test investigation. This study was conducted between September 2022 and November 2022, at the University College of Farasan in the Kingdom of Saudi Arabia. Quantitative data were obtained using the "Cardio Pulmonary Resuscitation Knowledge Questionnaire", "Students' Satisfaction and Self-Confidence Scale," and the "CPR Skill Checklist," which were applied to 75 participants in focus groups. Before the simulation-based CPR training, the students' mean pre-test Paediatric CPR knowledge score was 6.5±2.3 out of 42.0. After the simulation, the mean post-test CPR knowledge score (38.1±2.9) considerably improved (p 0.05). The mean post-test CPR skills score (44.7±1.2) was also considerably higher than the mean pre-test CPR skills score (11.4±2.8) at (p 0.05). Additionally, after the simulation training, students' happiness and confidence levels (61.9±2.2) greatly increased. Themes from the qualitative data showed that the simulation was viewed as an engaging and effective teaching tool by the students. Two themes emerged from the study: "Worries before simulation" and "Satisfaction after simulation". Simulation-based paediatric cardio Pulmonary resuscitation training program has raised nursing students' level of expertise in knowledge, performance, and self-efficacy. Additionally, strong satisfaction and self-confidence levels were discovered following the simulation training.

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation.

To determine the association between chest compression interruption (CCI) patterns and outcomes in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Cardiopulmonary resuscitation (CPR) data were collected using defibrillator-electrode and bedside monitor waveforms from pediatric ECPR cases between 2013 and 2021. Duration and variability of CCI during cannulation for ECPR was determined and compared with survival to discharge using Fishers exact test and logistic regressions with cluster-robust se s for adjusted analyses. Quaternary care children's hospital. Pediatric patients undergoing ECPR. None. Of 41 ECPR events, median age was 0.7 years (Q1, Q3: 0.1, 5.4), 37% (15/41) survived to hospital discharge with 73% (11/15) of survivors having a favorable neurologic outcome. Median duration of CPR from start of ECPR cannulation procedure to initiation of extracorporeal membrane oxygenation (ECMO) flow was 21 minutes (18, 30). Median duration of no-flow times associated with CCI during ECMO cannulation was 11 seconds (5, 28). Following planned adjustment for known confounders, survival to discharge was inversely associated with maximum duration of CCI (odds ratio [OR] 0.91 [0.86-0.95], p = 0.04) as well as the variability in the CCI duration (OR 0.96 [0.93-0.99], p = 0.04). Cases with both above-average CCI duration and higher CCI variability ( sd > 30 s) were associated with lowest survival (12% vs. 54%, p = 0.009). Interaction modeling suggests that lower variability in CCI is associated with improved survival, especially in cases where average CCI durations are higher. Shorter duration of CCI and lower variability in CCI during cannulation for ECPR were associated with survival following refractory pediatric cardiac arrest.

Multiple Causes of Death Associated with Pediatric Cardiopulmonary Arrest from 1996 to 2019 in Brazil.

In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents. To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths. Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC. From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases. Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.

Enhancing global pediatric cardiac arrest outcomes through bystander cardiopulmonary resuscitation: A comprehensive systematic review

This systematic review investigates the impact of global bystander cardiopulmonary resuscitation (CPR) on outcomes in pediatric cardiac arrest cases. Through a meticulous examination of relevant worldwide studies retrieved from PubMed spanning 2018 to 2022, employing keywords such as “worldwide Bystander CPR (BCPR),” “worldwide out-of-hospital CPR,” and “pediatric CPR” with Boolean operators “OR” and “AND,” the study incorporates 10 selected articles out of the initially identified 13. Findings reveal that bystander-initiated CPR, predominantly chest-only CPR, is administered at rates ranging from 48% to 89% globally, with no significant gender-based disparity, but a lower likelihood observed among worldwide Black children. Return of spontaneous circulation (ROSC) is achieved in 20%–35% of cases and survival to hospital discharge in 5%–10% of instances. Factors associated with worldwide prehospital ROSC include epinephrine administration, bystander intervention before emergency medical services (EMS) arrival, older age, reduced time to EMS response, and worldwide automated external defibrillators. Notably, a shorter time to EMS arrival is the sole significant predictor of worldwide survival to hospital discharge. The study discerns no substantial distinction in achieving prehospital ROSC and favorable outcomes on a global scale. The conclusion underscores the varied worldwide outcomes in out-of-hospital cardiac arrest studies, attributing these variations to multifarious confounding factors. It identifies crucial predictors of prehospital ROSC and recommends targeted CPR training for underserved communities to enhance worldwide BCPR rates and ameliorate pediatric cardiac arrest outcomes.

Early Cardiac Arrest Hemodynamics, End-Tidal C o2 , and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021).

Cannulation for extracorporeal membrane oxygenation during active extracorporeal cardiopulmonary resuscitation (ECPR) is a method to rescue patients refractory to standard resuscitation. We hypothesized that early arrest hemodynamics and end-tidal C o2 (ET co2 ) are associated with survival to hospital discharge with favorable neurologic outcome in pediatric ECPR patients. Preplanned, secondary analysis of pediatric Utstein, hemodynamic, and ventilatory data in ECPR patients collected during the 2016-2021 Improving Outcomes from Pediatric Cardiac Arrest study; the ICU-RESUScitation Project (ICU-RESUS; NCT02837497). Eighteen ICUs participated in ICU-RESUS. There were 97 ECPR patients with hemodynamic waveforms during cardiopulmonary resuscitation. None. Overall, 71 of 97 patients (73%) were younger than 1 year old, 82 of 97 (85%) had congenital heart disease, and 62 of 97 (64%) were postoperative cardiac surgical patients. Forty of 97 patients (41%) survived with favorable neurologic outcome. We failed to find differences in diastolic or systolic blood pressure, proportion achieving age-based target diastolic or systolic blood pressure, or chest compression rate during the initial 10 minutes of CPR between patients who survived with favorable neurologic outcome and those who did not. Thirty-five patients had ET co2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ET co2 less than 10 mm Hg and two (12%) had a maximum ET co2 less than 10 mm Hg during the initial 10 minutes of resuscitation. We did not identify an association between early hemodynamics achieved by high-quality CPR and survival to hospital discharge with favorable neurologic outcome after pediatric ECPR. Candidates for ECPR with ET co2 less than 10 mm Hg may survive with favorable neurologic outcome.

Parental supporter during pediatric resuscitation: Qualitative exploration of caregivers' and healthcare professionals' experiences and perceptions

BackgroundChild resuscitation is a critical and stressful time for family caregivers and healthcare professionals. The aim of this study was to explore caregivers’ and healthcare professionals’ experiences and perceptions of a parental supporter during pediatric cardiopulmonary resuscitation to provide guidance to healthcare professionals on supporting parents and other family caregivers during resuscitation. MethodsThis study used an exploratory descriptive qualitative approach. The setting was two large referral pediatric governmental hospitals. Participants were 17 caregivers who had experienced their child’s resuscitation, and 13 healthcare professionals who served on resuscitation teams in emergency rooms or intensive care wards. Semi-structured, in-depth interviews were conducted and data were analyzed using thematic analysis. COREQ guidelines were followed. ResultsParticipants shared their experiences and perceptions of a parental supporter during pediatric resuscitation in three themes: 1) Requirement for the presence of a parental supporter, 2) Expectations of the parental supporter, and 3) Characteristics of the parental supporter. ConclusionsStudy findings highlight the need for a parental supporter during pediatric resuscitation; however, there is no defined parental supporter role in current guiding policies due to limited research on this role. More research on the parental supporter role is needed so effective policies and protocols can be developed to enhance family-centered care practices in pediatric emergency and acute care settings.

Abstract 382: The Effect of Stepstool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative

Background: Delivering chest compressions (CC) of adequate depth and rate during pediatric cardiopulmonary resuscitation (CPR) has known beneficial hemodynamic consequences; however, chest compression quality in this population is often suboptimal. While common, the benefit of stepstool use during pediatric CPR has not been studied. Objective: To analyze the effect of step stool use on chest compression quality (depth, rate) in a pediatric emergency department (ED). Methods: We conducted a prospective observational cohort study involving patients <8 years of age receiving chest compressions in an ED for >2 minutes. Data was collecting via structured video review and from a CC monitoring device. Analysis was by compressor segment. We compared CC rate and depth by step stool use in each of 3 age groups: < 1 year, 1-8 years, 9-18 years. We also examined step stool and CC quality by compressor hand position: 1) two thumbs, hands encircling chest (2T), 2) two fingers, 2 nd and 3 rd digits, pressing on anterior sternum (2F), 3) one hand (1H), and4) two hands (2H). Results: 46 patients received 390 CC segments (565 total minutes of CC). In patient <1 year and 1-8years of age, the majority of compressors utilized a step stool (73% <1 year; 83.3% 1-8 years). For <1year, there was no difference in mean CC rate or depth with or without step stool use. In children >1year of age, a step stool was associated with deeper chest compressions [3.63cm (IQR 3.07 - 4.17)versus 2.74 cm (IQR 2.39 - 3.24) without, p=0.000] and a mean CC rate more consistent with AHA guidelines [115 compressions per minute (IQR 115 - 128) versus 125 (IQR 110 - 121) without p=0.0037]. Stratified by hand placement technique, 1H compressions with a step stool achieved greater depth in children >1 years (p<0.01); 2H compressions with a step stool achieved a more compliant CC rate in children >1 years (p<0.05). Conclusions: CPR depth failed to reliably meet AHA guidelines regardless of stepstool use across all age categories. However, in children between 1 - 8 years of age, step stool use was significantly associated with higher quality chest compressions. Our findings of better CC depth and rate with one and two hand compressions should prompt further investigation and evaluation of CC technique in the pediatric population.

Abstract 274: Association of Tracheal Intubation Associated Interruptions in Cardiopulmonary Resuscitation and Chest Compression Fraction During Pediatric Cardiac Arrest: A Report From the Videography in Pediatric Resuscitation Collaborative

Background: Performing tracheal intubation during pediatric cardiopulmonary resuscitation has been consistently associated with worsened clinical outcomes in observational studies. One theoretical explanation for these differences is that pauses in chest compressions during attempt(s) at TI result in a decreased chest compression fraction (CCF). Objective: To examine the impact of TI attempts on CCF in children during CPR in a network of tertiary pediatric EDs. Methods: Prospective observation study from the Videography In Pediatric Resuscitation (VIPER) Collaborative. All patients receiving CPR under videorecorded conditions were eligible for enrollment. Using video review, data was collected on CPR duration, TI attempts, and the occurrence and duration of CPR interruptions during TI attempts. CCF was calculated as the total duration of CPR (100%) minus the total time of all CPR interruptions (including pauses for TI). Using nonparametric methods, univariate comparison was made between CPR events with TI-associated CPR interruptions versus CPR events without TI associated interruptions (i.e. CPR event with CPR uninterrupted during TI attempts or with no TI attempts made). Results: 111 CPR events across four sites were analyzed. The median CCF across all events was 92% (IQR 87 - 94%). At least one TI attempt was made in 40/111 (36%) of CPR events; 29/40 (75%) of these CPR events had at least 1 CPR interruption associated with TI attempt(s). There was no significant difference in CCF between CPR events with at least one TI attempt and CPR events without any TI-associated pauses (89% vs. 92%, p=0.06). Conclusions: Pediatric cardiac arrests with TI attempts made during CPR did not have significantly shorter CCF than arrests without TI attempts. Our findings refute the hypothesis that worsened clinical outcomes in children who undergo TI during CPR are due to poorer CCF, and further research should try to examine other explanations for the association between TI during CPR and poor outcomes.

Abstract 104: Photoplethysmogram Signal Characteristics as a Non-Invasive Surrogate of Diastolic Blood Pressure During Cardiopulmonary Resuscitation

Background: During cardiopulmonary resuscitation (CPR), diastolic blood pressure (DBP) is a key driver of coronary perfusion pressure and thereby, blood flow during CPR. Although resuscitation guidelines advise measuring DBP as an indicator of CPR quality, the need for an invasive arterial catheter to measure DBP limits scope of patients for whom a BP-directed CPR strategy can be implemented. Aims and Hypothesis: We aimed to study the photoplethysmogram (PPG) signal acquired from pulse oximetry monitoring as a non-invasive indicator of CPR quality. We hypothesized that a machine learning algorithm using dynamic PPG features would accurately classify CPR segments according to whether they met established pediatric DBP thresholds associated with improved outcomes (≥25mmHg in infants and ≥30 mmHg in older children). Methods/Approach: This was an NHLBI-funded ancillary study of the ICU-RESUScitation clinical trial (NCT02837497). This initial pilot study included 12 children who received CPR for an IHCA and had both arterial BP and pulse oximetry monitoring in place. Physiologic data were summarized into five-second epochs and DBP for each epoch was dichotomized by whether it met age-based DBP thresholds. Time-domain features ( k =25) were systematically engineered from the PPG signal, and a Support Vector Machine (SVM) model with a Gaussian kernel was trained to classify the CPR quality samples. Results: The analysis yielded n= 268 five-second CPR epochs, of which 147 (55.9%) met DBP thresholds. In the testing set of 134 previously unseen samples (50% of n , n low =59, n high =75), the SVM model achieved a classification accuracy of 91% with 100% precision and specificity, 79.7% sensitivity, and a negative predictive value of 86.2% only influenced by false negatives. Throughout development, six features describing the dicrotic notch characteristics reflected in the PPG waveform were empirically observed as significant CPR quality indicators. Conclusion: In this multicenter pilot investigation, the PPG waveform derived from pulse oximetry readings showed promise as a non-invasive surrogate of invasively measured DBP during pediatric CPR. This has the potential to greatly broaden the population for whom physiologic monitoring during CPR is possible.

Abstract 280: Effectiveness of Bag-Valve-Mask Ventilation During Out-of-Hospital Pediatric CPR

Background: Few studies have measured ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement. Resuscitation guidelines recommend pauses after every 15 or 30 chest compressions to deliver ventilations for children. The effectiveness of bag-valve-mask (BVM) ventilation delivered during the pause in chest compressions is unknown. Hypothesis: Lung inflation occurs infrequently with BVM ventilation during 30:2 (and 15:2) CPR. Aim: To determine the incidence of lung inflation with BVM ventilation during 15:2 or 30:2 CPR for pediatric OHCA. Methods: This is a retrospective, observational study of 63 OHCA patients, <18 years of age, with non-traumatic cardiac arrest from the Dallas-Fort Worth Center for Resuscitation Research registry. Emergency medical service rescuers provided 30:2 or 15:2 CPR with BVM ventilation and ≥ 2 min of recorded CPR. We measured bioimpedance ventilation (lung inflation) waveforms in the pauses between chest compression segments recorded through defibrillation pads. A detectable ventilation waveform had a bioimpedance amplitude ≥0.5 Ohm and duration ≥1 sec. We measured the incidence of ventilation in two pre-specified groups: patients with ventilation waveforms in <50% of pauses (Group 1) vs. those with waveforms in ≥50% of pauses (Group 2). Results: The mean duration of 30:2 or 15:2 CPR was 15(8) min prior to advanced airway placement. During this period, we identified 683 pauses in chest compressions, 386 measurable ventilations, and the median (IQR) number of ventilations was 2 (0-4). Of 20 advanced airway attempts, nine were successful.Group 1 (N=48) had a median 8 pauses and 1.5 ventilations/patient, Group 2 (N= 15) had a median 10 pauses and 12 ventilations/patient (Table). Return of spontaneous circulation for Group 1 (15%, 7/48) vs. Group 2 (33%, 5/15). Conclusion: This study shows that use of a BVM device results in infrequent lung inflation during 30:2 or 15:2 CPR in pediatric patients.

Abstract 102: Early Bolus Epinephrine Administration During Pediatric Cardiopulmonary Resuscitation for Bradycardia With Poor Perfusion

Introduction: Though epinephrine is recommended during CPR for children with bradycardia with poor perfusion, a registry study identified an association between epinephrine administration and worse outcomes. Our objective was to use granular data from the ICU-RESUScitation (ICU-RESUS) trial, including markers of illness severity not available in registries, to further investigate epinephrine use in this population. We hypothesized that when controlling for patient characteristics, early epinephrine administration would be associated with superior outcomes in children receiving CPR for bradycardia with poor perfusion. Methods: Prespecified secondary analysis of ICU-RESUS, a multicenter cluster randomized trial of pediatric (<19 years) IHCA in 18 PICUs. Index events (October 2016 to March 2021) lasting 2 minutes with an initial rhythm of bradycardia with poor perfusion were included. Early administration of bolus epinephrine (first 2 minutes of CPR) was chosen as the exposure since pulselessness during CPR for bradycardia with poor perfusion develops at a median of 3 minutes. The association between early epinephrine and outcomes was evaluated with Poisson multivariable regression controlling for a priori pre-arrest characteristics including Pediatric Risk of Mortality (PRISM) score and vasoactive inotropic score (VIS). Results: Of 452 patients, 322 (71.2%) received early epinephrine. The early epinephrine group had higher PRISM and VIS and more frequently received calcium and sodium bicarbonate. On univariate analysis, the early epinephrine group had lower, but not statistically significantly, rates of survival to discharge (174/322 [54%] vs 82/130 [63%], p=0.093) and survival with favorable neurologic outcome (164/322 [51%] vs 75/130 [58%], p=0.212). In multivariable analysis, early epinephrine was not associated with survival to discharge (RR 0.97, 95% CI 0.82, 1.14) or survival with favorable neurologic outcome (RR 0.99, 95% CI 0.82, 1.18). Conclusion: In this cohort of pediatric IHCA with an initial rhythm of bradycardia with poor perfusion, early bolus epinephrine was not associated with outcomes when controlling for illness severity. Further work should focus on which patients with this rhythm benefit from epinephrine.

Parental perceptions of the importance of pediatric out-of-hospital cardiopulmonary resuscitation for the survival rate in Saudi Arabia: a cross-sectional survey

BackgroundPediatric out-of-hospital cardiac arrest is associated with high morbidity and mortality rates. Cardiopulmonary resuscitation (CPR), the practice of chest compressions combined with rescue breathing, is crucial for the success of out-of-hospital resuscitation after sudden cardiac arrest. Thus, imparting the requisite knowledge and skills to parents/caregivers can significantly enhance survival rates. This study investigated parental awareness of the impact of out-of-hospital pediatric CPR on survival rates in Saudi Arabia.MethodsThis cross-sectional study was conducted using an online questionnaire administered to Saudi parents from all regions of the Kingdom of Saudi Arabia. Data were collected using the convenience sampling method, as the questionnaire was distributed via social media platforms. The questionnaire consisted of five parts: (1) demographic data, (2) questions about parents’ perception of basic life support (BLS), (3) evaluation of parents’ knowledge of the impact of prehospital CPR on survival rates, (4) measurement of parents’ competency in performing pediatric CPR, and (5) assessment of whether parents’ confidence was affected by prior training. Statistical analyses were conducted using the chi-squared test or Fisher’s exact test, and the t-test was used to compare the mean scores of the groups of parents with medical and non-medical professional backgrounds.ResultsA total of 1,065 individuals responded to the survey. The respondents’ mean age was 41 ± 0.2 years and 46.5% were men. We found that 73.9% of respondents had no prior experience with BLS, 87% had never taken a BLS course, and 61% did not know where to find one. The majority of participants agreed that bystander CPR contributes to overall survival rates, and 77% agreed to the importance of BLS training. Medical professionals showed a higher percentage of agreement on the importance of BLS than those from non-medical backgrounds (90% vs. 76%, p = 0.036), especially parents of high-risk children.ConclusionThis study showed evidence of interest in CPR and BLS training in Saudi parents, despite the low levels of knowledge regarding BLS training.

140 Comparisons of the vertical one-handed chest compressions during pediatric cardiopulmonary resuscitation according to the rescuer's handedness

140 Comparisons of the vertical one-handed chest compressions during pediatric cardiopulmonary resuscitation according to the rescuer's handedness

93 Clinical simulation in paediatric and newborn cardiopulmonary resuscitation: A quasi-experimental study of nursing students' knowledge and satisfaction

93 Clinical simulation in paediatric and newborn cardiopulmonary resuscitation: A quasi-experimental study of nursing students' knowledge and satisfaction

Pediatric extracorporeal cardiopulmonary resuscitation for yew cardiotoxicity.

English yew is an evergreen conifer frequently planted in household gardens and, when ingested in large doses, results in severe cardiotoxicity characterized by difficult to control ventricular arrhythmias with high rates of mortality. A previously healthy teenage female presented as an out-of-hospital cardiac arrest with refractory ventricular arrhythmias and severe biventricular dysfunction. Due to rapid deterioration in her clinical status, she was cannulated onto venoarterial extracorporeal membrane oxygenation (ECMO) which resulted in rapid normalization of her rhythm and ventricular function. Our case highlights the importance of keeping a broad differential diagnosis when considering etiologies of ventricular arrhythmias in the pediatric population. The final diagnosis was not made until after discharge and implantable cardiac defibrillator (ICD) placement. The delayed diagnosis of this intentional English yew ingestion ultimately resulted subsequent ICD removal. Early ECMO activation in cases of English yew toxicity can be essential for patient survival.

Comparison of video-assisted education and traditional classroom education in pediatric cardiopulmonary resuscitation education of nursing students

AimThis research aimed to compare the effectiveness of traditional classroom education and video-assisted education methods used in Pediatric (CPR) education and determine students' level of satisfaction with the education methods used. MethodThis research had a randomized, experimental, pretest-posttest design. The research was completed with 98 students (54 in the video-assisted education group and 44 in the traditional classroom education group). The traditional classroom education group received pediatric CPR education through traditional classroom education. On the other hand, the video-assisted education group watched the pediatric CPR education video prepared by the researchers. The level of knowledge of pediatric CPR, the level of pediatric CPR practice skills, and the satisfaction score of each student were evaluated. ResultsWhen the skills levels of the groups were compared, it was determined that there was no statistical difference between the test results. In both groups, the students' mean knowledge and skill scores in the first and second posttests were significantly higher than their pretest knowledge scores. The satisfaction scores of the students in both groups were similar. ConclusionBoth methods effectively improve students' pediatric CPR-related knowledge, skills, and satisfaction. Implications for practiceAs support for traditional education, using video-assisted visual education materials that nursing students can constantly access when needed is important.

Prediction of Return of Spontaneous Circulation in a Pediatric Swine Model of Cardiac Arrest Using Low-Resolution Multimodal Physiological Waveforms.

Monitoring physiological waveforms, specifically hemodynamic variables (e.g., blood pressure waveforms) and end-tidal CO2 (EtCO2), during pediatric cardiopulmonary resuscitation (CPR) has been demonstrated to improve survival rates and outcomes when compared to standard depth-guided CPR. However, waveform guidance has largely been based on thresholds for single parameters and therefore does not leverage all the information contained in multimodal data. We hypothesize that the combination of multimodal physiological features improves the prediction of the return of spontaneous circulation (ROSC), the clinical indicator of short-term CPR success. We used machine learning algorithms to evaluate features extracted from eight low-resolution (4 samples per minute) physiological waveforms to predict ROSC. The waveforms were acquired from the 2nd to 10th minute of CPR in pediatric swine models of cardiac arrest (N = 89, 8-12 kg). The waveforms were divided into segments with increasing length (both forward and backward) for feature extraction, and machine learning algorithms were trained for ROSC prediction. For the full CPR period (2nd to 10th minute), the area under the receiver operating characteristics curve (AUC) was 0.93 (95% CI: 0.87-0.99) for the multivariate model, 0.70 (0.55-0.85) for EtCO2 and 0.80 (0.67-0.93) for coronary perfusion pressure. The best prediction performances were achieved when the period from the 6th to the 10th minute was included. Poor predictions were observed for some individual waveforms, e.g., right atrial pressure. In conclusion, multimodal waveform features carry relevant information for ROSC prediction. Using multimodal waveform features in CPR guidance has the potential to improve resuscitation success and reduce mortality.

Implications of pediatric extracorporeal cardiopulmonary resuscitation simulation for intensive care team confidence and coordination: A pilot study.

Extracorporeal cardiopulmonary resuscitation (ECPR) is associated with improved outcomes in select populations, however, crisis resource management (CRM) in this setting is logistically challenging. This study evaluates the impact of ECPR simulation on self-perceived confidence and collaboration of intensive care unit team members. This is a prospective observational study analyzing data obtained between July 2018-December 2019. This study focused on non-surgical members of critical care team consisting of pediatric intensivists, resident physicians, registered nurses, respiratory therapists. Participants were expected to perform cardiopulmonary resuscitation (CPR) during the ECPR event, participate in code-team responsibilities and provide ancillary support during cannulation. Pre- and post-simulation surveys employed the Likert scale (1 = not at all confident, 5 = highly confident) to assess self-perceived scores in specified clinical competencies. Twenty-nine providers participated in the simulation; 38% had prior ECPR experience. Compared to mean pre-study Likert scores (2.4, 2.4, 2.5), post-simulation scores increased (4.2, 4.4, 4.3) when self-evaluating: confidence in assessing patients needing ECPR, confidence in participating in ECPR workflow and confidence in performing high-quality CPR, respectively. Post-simulation values of >3 were reported by 100% of participants in all domains (p < .0001). All participants indicated the clinical scenario and procedural environment to be realistic and appropriately reflective of situational stress. Additionally, 100% of participants reported the simulation to improve perceived team communication and teamwork skills. This study demonstrated preliminary feasibility of pediatric ECPR simulation in enhancing independent provider confidence and team communication. This self-perceived improvement may establish a foundation for cohesive CRM, in preparation for a real life ECPR encounter.

19: Epinephrine dosing during pediatric extracorporeal cardiopulmonary resuscitation (ECPR): A single center retrospective study assessing adherence to resuscitation guidelines.

19: Epinephrine dosing during pediatric extracorporeal cardiopulmonary resuscitation (ECPR): A single center retrospective study assessing adherence to resuscitation guidelines.