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Background: Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. Methods: This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Results: Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Conclusions: Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics.
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Bhowmick R, Gulla KM. Pediatric Acute Respiratory Distress Syndrome in COVID-19 Pandemic: Is it the Puzzle of the Century? Indian J Crit Care Med 2022;26(3):264-265.
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BACKGROUND: Practice and knowledge of extracorporeal cardiopulmonary resuscitation (ECPR) in an Indian setting is not known. The etiology could be multifactorial, such as lack of awareness, lack of facilities, and lack of finances. Unless we identify and rectify the underlying problems, utilization of this aspect of extracorporeal membrane oxygenation (ECMO) support would be difficult. MATERIALS AND METHODS: This cross-sectional observational study was done over 6 months in three phases: (A) Formation of questionnaire/tool kit by Delphi method for 1 month (July 2019), (B) circulation of questionnaire to participants in the form of Google Forms and data collection for 2 months (August and October 2019), and (C) analysis, compilation of data, and writing the final report over 1 month (November 2019). RESULTS: Sixty-four participants responded. The majority of the respondents were intensivists (50%). Only six respondents (9.5%) had done ECPR at their center with median ECPRs per year of 2 (1-10). All ECPRs were being done in private sector hospitals. The most common indication for initiation was conventional cardiopulmonary resuscitation (CPR) for more than 10 minutes without return of spontaneous circulation (ROSC)(n = 4, 66%). In all cases, the intensivists took decision for the initiation of ECPR. The rest 57 did not have the experience of ECPR at their center due to lack of equipment and experience (50%) and financial issues (50%). CONCLUSION AND CLINICAL SIGNIFICANCE: There is a huge need to increase the awareness of the ECPR program and teams to be trained in India. We also suggest that the tertiary care medical institutions in public sector as well as the private sector that is offering critical care courses should train fellows on ECPR to employ it at times when needed to improve the outcomes of critically ill patients. HOW TO CITE THIS ARTICLE: Gulla K M, Sahoo T, Pooboni S K, et al. Extracorporeal Cardiopulmonary Resuscitation in Indian Scenario: A Web-based Survey. Indian J Crit Care Med 2021;25(6):675-679.
