Is the Over-the-Head Technique an Alternative for Infant CPR Performed by a Single Rescuer? A Randomized Simulation Study with Lifeguards.

(1) Objective: The objective was to evaluate the quality of cardiopulmonary resuscitation (CPR, chest compressions and ventilations) when performed by a lone first responder on an infant victim via the over-the-head technique (OTH) with bag-mask ventilation in comparison with the standard lateral technique (LAT) position. (2) Methods: A randomized simulation crossover study in a baby manikin was conducted. A total of 28 first responders performed each of the techniques in two separate CPR tests (15:2 chest compressions:ventilations ratio), each lasting 5 min with a 15 min resting period. Quality CPR parameters were assessed using an app connected to the manikin. Those variables were related to chest compressions (CC: depth, rate, and correct CC point) and ventilation (number of effective ventilations). Additional variables included perceptions of the ease of execution of CPR. (3) Results: The median global CPR quality (integrated CC + V) was 82% with OTH and 79% with LAT (p = 0.94), whilst the CC quality was 88% with OTH and 80% with LAT (p = 0.67), and ventilation quality was 85% with OTH and 85% with LAT (p = 0.98). Correct chest release was significantly better with OTH (OTH: 92% vs. LAT: 62%, p < 0.001). There were no statistically significant differences in the remaining variables. Ease of execution perceptions favored the use of LAT over OTH. (4) Conclusions: Chest compressions and ventilations can be performed with similar quality in an infant manikin by lifeguards both with the standard recommended position (LAT) and the alternative OTH. This option could give some advantages in terms of optimal chest release between compressions. Our results should encourage the assessment of OTH in some selected cases and situations as when a lone rescuer is present and/or there are physical conditions that could impede the lateral rescue position.

Nueva herramienta de comunicación para el entrenamiento de soporte vital básico: smart glasses. Un diseño cuasiexperimental / New communication tool for basic life support training: smart glasses. A quasi-experimental study

Objetivo Analizar la efectividad de una metodología de enseñanza-aprendizaje de teleformación en soporte vital básico (SVB) basada en la comunicación a través de smart glasses. Diseño Estudio piloto cuasiexperimental de no inferioridad. Participantes Un total de 60 estudiantes universitarios. Intervenciones Aleatorización de los participantes en: grupo de teleformación a través de smart glasses (SG) y de formación tradicional (C). Ambas sesiones de entrenamiento fueron muy breves (<8 minutos) e incluyeron el mismo contenido en SVB. En SG, la capacitación fue comunicándose a través de una videollamada con smart glasses. Variables de interés principales Se evaluó el protocolo del SVB, el uso de desfibrilador externo automático (DEA), la calidad de la reanimación y los tiempos de actuación. Resultados En la mayoría de las variables del protocolo del SVB, la calidad de la reanimación y los tiempos de ejecución no hubo diferencias estadísticamente significativas entre grupos. Hubo mejor actuación de SG al valorar la respiración (SG: 100%, C: 81%; p=0,013), el avisar antes de la descarga del DEA (SG: 79%, C: 52%; p=0,025) y las compresiones con buena reexpansión (SG: 85%, C: 32%; p=0,008). Conclusiones El tele-entrenamiento en SVB-DEA para legos con smart glasses podría llegar a ser, al menos, tan efectivo como un método tradicional de enseñanza. Además, las smart glasses podrían ser más ventajosas para ciertos aspectos del protocolo del SVB y la calidad de las compresiones, probablemente debido a la capacidad de visualización de imágenes en tiempo real. La enseñanza basada en la realidad aumentada debe considerarse para la capacitación en SVB, aunque se requiere tanto cautela en la extrapolación de hallazgos como estudios futuros con mayor profundidad. (AU)

Aim To analyze the effectiveness of a teaching-learning methodology for teletraining in basic life support (BLS) based on communication through smart glasses. Design Pilot quasi-experimental non-inferiority study. Participants Sixty college students. Interventions Randomization of the participants in: tele-training through smart glasses (SG) and traditional training (C) groups. Both training sessions were very brief (less than 8 minutes) and included the same BLS content. In SG, the instructor trained through a video call with smart glasses. Main variables of interest The BLS protocol, the use of AED, the quality of resuscitation and the response times were evaluated. Results In most of the BLS protocol variables, the resuscitation quality and performance times, there were no statistically significant differences between groups. There were significant differences (in favor of the SG) in the assessment of breathing (SG: 100%, CG: 81%; p=0.013), the not-to-touch warning before applying the shock (SG: 79%, CG: 52%; p=0.025) and compressions with correct recoil (SG: 85%, CG: 32%; p=0.008). Conclusions Laypeople BLS-AED brief tele-training through smart glasses could potentially be, at least, as effective as traditional training methods. In addition, smart glasses could be more advantageous than traditional teaching for certain points of the BLS protocol and chest compressions quality, probably due to the capability of real-time visualization of images which supports the BLS sequence. Augmented reality supported teaching should be considered for BLS training, although caution is required in extrapolating findings, and further in-depth studies are needed to confirm its potential role depending on concrete target populations and environments. (AU)

New communication tool for basic life support training: smart glasses. A quasi-experimental study.

AIM: To analyze the effectiveness of a teaching-learning methodology for teletraining in basic life support (BLS) based on communication through smart glasses. DESIGN: Pilot quasi-experimental non-inferiority study. PARTICIPANTS: Sixty college students. INTERVENTIONS: Randomization of the participants in: tele-training through smart glasses (SG) and traditional training (C) groups. Both training sessions were very brief (less than 8 min) and included the same BLS content. In SG, the instructor trained through a video call with smart glasses. MAIN VARIABLES OF INTEREST: The BLS protocol, the use of AED, the quality of resuscitation and the response times were evaluated. RESULTS: In most of the BLS protocol variables, the resuscitation quality and performance times, there were no statistically significant differences between groups. There were significant differences (in favor of the SG) in the assessment of breathing (SG: 100%, C: 81%; p = 0.013), the not-to-touch warning before applying the shock (SG: 79%, C: 52%; p = 0.025) and compressions with correct recoil (SG: 85%, C: 32%; p = 0.008). CONCLUSIONS: Laypeople BLS-AED brief tele-training through smart glasses could potentially be, at least, as effective as traditional training methods. In addition, smart glasses could be more advantageous than traditional teaching for certain points of the BLS protocol and chest compressions quality, probably due to the capability of real-time visualization of images which supports the BLS sequence. Augmented reality supported teaching should be considered for BLS training, although caution is required in extrapolating findings, and further in-depth studies are needed to confirm its potential role depending on concrete target populations and environments.

[Prevención del ahogamiento desde la educación para la salud escolar. Evaluación del proyecto piloto SOS 112.] / Drowning prevention through school health education. Evaluation of the SOS 112 pilot project.

OBJECTIVE: Drowning represents one of the main causes of child mortality. Water-related incidents are preventable and should be addressed through health education. The aim of this study was to evaluate an educational program for eight-year-old students based on a song with content on drowning prevention. METHODS: A feasibility pilot study was conducted, including forty-six children enrolled in a public school in Santiago de Compostela (A Coruña, Spain). The study was developed in three phases. In the first step, a group of experts and musicians created the educational content and the song. Secondly, the evaluation tool was developed, and finally, the program was implemented based on flag recognition, how to help in a drowning situation, safe swimming attitudes, and information about the emergency phone number 112. The percentage of correct responses by children before and after the educational intervention were compared using the McNemar test. RESULTS: Approximately half of the children were unaware of the meaning of the flags. After listening to the song, all students identified the meaning of the red flag, and over 90% recognized the green and yellow flags (p<0.001). Before the intervention, children correctly identified, on average, 75.3% of the safe water attitude pictograms. This perception of safe attitudes significantly increased post-intervention (p<0.001), with recognition of 86.4% of the correct behaviours. The overall water safety score also significantly improved by 22.7% after the intervention (p<0.001). CONCLUSIONS: The educational song is a resource to promote the learning of signals and concepts related to child drowning prevention.

OBJETIVO: El ahogamiento representa una de las principales causas de mortalidad infantil. Los incidentes acuáticos son prevenibles y deben ser abordados desde la educación para la salud. El objetivo de este estudio fue evaluar un programa educativo en alumnado de ocho años basado en una canción con contenido para la prevención del ahogamiento. METODOS: Se realizó un estudio piloto de viabilidad que incluyó a cuarenta y seis niños/as escolarizados en un centro público de Santiago de Compostela (A Coruña, España), siendo desarrollado en tres fases. En el primer paso, un grupo de expertos y músicos crearon el contenido educativo y la canción. En segundo lugar, se elaboró la herramienta de evaluación y, finalmente, se implementó el programa basado en el reconocimiento de las banderas, en cómo ayudar en un ahogamiento, en las actitudes seguras para el baño y en información sobre el teléfono de emergencias 112. El porcentaje de respuestas correctas antes y después de la intervención educativa se compararon utilizando la prueba de McNemar. RESULTADOS: Aproximadamente la mitad de los niños/as desconocía el significado de las banderas. Después de la audición de la canción, todos los escolares identificaron el significado de la bandera roja y más del 90% reconoció la bandera verde y amarilla (p<0,001). Antes de la intervención, los niños identificaron correctamente, en promedio, el 75,3% de los pictogramas de actitudes acuáticas seguras. Esta percepción de actitudes seguras aumentó significativamente postintervención (p<0,001), reconociendo el 86,4% de las conductas correctas. La puntuación general de seguridad del agua también mejoró significativamente después de la intervención un 22,7% (p<0,001). CONCLUSIONES: La canción educativa es un medio para favorecer el aprendizaje de las señales y conceptos sobre la prevención del ahogamiento infantil.

School children brief training to save foreign body airway obstruction.

Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate action will determine the victim's outcome. Although many school children's basic life support (BLS) training programs have been implemented in recent years, references to specific training on FBAO are lacking. Therefore, the aim was to assess FBAO-solving knowledge acquisition in 10-13-year-old school children. A quasi-experimental non-controlled simulation study was carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia (Spain). Participants received a 60-min training led by their physical education teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on training) on how to help to solve an FBAO event. After the training session, the school children's skills were assessed in a standardized adult's progressive FBAO simulation scenario. The assessment was carried out by proficient researchers utilizing a comprehensive checklist specifically designed to address the variables involved in resolving a FBAO event according with current international guidelines. The assessment of school children's acquired knowledge during the simulated mild FBAO revealed that 62.2% of participants successfully identified the event and promptly encouraged the simulated patient to cough actively. When the obstruction progressed, its severity was recognized by 86.2% and back blows were administered, followed by abdominal thrusts by 90.4%. When the simulated victim became unconscious, 77.1% of children identified the situation and immediately called the emergency medical service and 81.1% initiated chest compressions. No significant differences in performance were detected according to participants' age.  Conclusion: A brief focused training contributes to prepare 10-13-year-old school children to perform the recommended FBAO steps in a standardized simulated patient. We consider that FBAO should be included in BLS training programs for school children. What is Known: • Kids Save Lives strategy states that school children should learn basic life support (BLS) skills because of their potential role as first responders. • This BLS training does not include content for resolving a foreign body airway obstruction (FBAO). What is New: • Following a 60-min theoretical-practical training led by physical education teachers, 10-13-year-old school children are able to solve a simulated FBAO situation. • The inclusion of FBAO content in BLS training in schools should be considered.

Trained Lifeguards Performing Pediatric Cardiopulmonary Resuscitation While Running: A Pilot Simulation Study.

The aim of this study was to compare the quality of standard infant CPR with CPR in motion (i.e., walking and running) via performing maneuvers and evacuating the infant from a beach. Thirteen trained lifeguards participated in a randomized crossover study. Each rescuer individually performed three tests of 2 min each. Five rescue breaths and cycles of 30 chest compressions followed by two breaths were performed. Mouth-to-mouth-and-nose ventilation was carried out, and chest compressions were performed using the two-fingers technique. The manikin was carried on the rescuer's forearm with the head in the distal position. The analysis variables included compression, ventilation, and CPR quality variables, as well as physiological and effort parameters. Significantly lower compression quality values were obtained in running CPR versus standard CPR (53% ± 14% versus 63% ± 15%; p = 0.045). No significant differences were observed in ventilation or CPR quality. In conclusion, lifeguards in good physical condition can perform simulated infant CPR of a similar quality to that of CPR carried out on a victim who is lying down in a fixed position.

Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video streaming via smart glasses and telephone instructions.

OBJECTIVE: To determine whether dispatcher assistance via smart glasses improves bystander basic life support (BLS) performance compared with standard telephone assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario. METHODS: Pilot study in which 28 lay people randomly assigned to a smart glasses-video assistance (SG-VA) intervention group or a smartphone-audio assistance (SP-AA) control group received dispatcher guidance from a dispatcher to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a video call with smart glasses (Vuzix, Blade) connected to a wireless network, while SP-AA rescuers received instructions over a smartphone with the speaker function activated. BLS protocol steps, quality of chest compressions, and performance times were compared. RESULTS: Nine of the 14 SG-VA rescuers correctly completed the BLS protocol compared with none of the SP-AA rescuers (p = 0.01). A significantly higher number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002), checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay clear before delivering the shock (12 vs. 0, p < 0.001). No significant differences were observed for performance times or chest compression quality. The mean compression rate was 104 compressions per minute in the SG-VA group and 98 compressions per minute in the SP-AA group (p = 0.46); mean depth of compression was 4.5 cm and 4.4 cm (p = 0.49), respectively. CONCLUSIONS: Smart glasses could significantly improve dispatcher-assisted bystander performance in an OHCA event. Their potential in real-life situations should be evaluated.

Prevención del ahogamiento desde la educación para la salud escolar. Evaluación del proyecto piloto SOS 112 / Drowning prevention through school health education. Evaluation of the SOS 112 pilot project

FUNDAMENTOS: El ahogamiento representa una de las principales causas de mortalidad infantil. Los incidentes acuáticos sonprevenibles y deben ser abordados desde la educación para la salud. El objetivo de este estudio fue evaluar un programa educativoen alumnado de ocho años basado en una canción con contenido para la prevención del ahogamiento. MÉTODOS: Se realizó un estudio piloto de viabilidad que incluyó a cuarenta y seis niños/as escolarizados en un centro público deSantiago de Compostela (A Coruña, España), siendo desarrollado en tres fases. En el primer paso, un grupo de expertos y músicoscrearon el contenido educativo y la canción. En segundo lugar, se elaboró la herramienta de evaluación y, finalmente, se implementóel programa basado en el reconocimiento de las banderas, en cómo ayudar en un ahogamiento, en las actitudes seguras para elbaño y en información sobre el teléfono de emergencias 112. El porcentaje de respuestas correctas antes y después de la intervencióneducativa se compararon utilizando la prueba de McNemar. RESULTADOS: Aproximadamente la mitad de los niños/as desconocía el significado de las banderas. Después de la audición dela canción, todos los escolares identificaron el significado de la bandera roja y más del 90% reconoció la bandera verde y amarilla(p<0,001). Antes de la intervención, los niños identificaron correctamente, en promedio, el 75,3% de los pictogramas de actitudesacuáticas seguras. Esta percepción de actitudes seguras aumentó significativamente postintervención (p<0,001), reconociendo el86,4% de las conductas correctas. La puntuación general de seguridad del agua también mejoró significativamente después de laintervención un 22,7% (p<0,001). CONCLUSIONES: La canción educativa es un medio para favorecer el aprendizaje de las señales y conceptos sobre la prevencióndel ahogamiento infantil.(AU)

BACKGROUND: Drowning represents one of the main causes of child mortality. Water-related incidents are preventable and shouldbe addressed through health education. The aim of this study was to evaluate an educational program for eight-year-old studentsbased on a song with content on drowning prevention. METHODS: A feasibility pilot study was conducted, including forty-six children enrolled in a public school in Santiago de Compostela(A Coruña, Spain). The study was developed in three phases. In the first step, a group of experts and musicians created the educationalcontent and the song. Secondly, the evaluation tool was developed, and finally, the program was implemented based on flag recognition,how to help in a drowning situation, safe swimming attitudes, and information about the emergency phone number 112. The percentageof correct responses by children before and after the educational intervention were compared using the McNemar test. RESULTS: Approximately half of the children were unaware of the meaning of the flags. After listening to the song, all studentsidentified the meaning of the red flag, and over 90% recognized the green and yellow flags (p<0.001). Before the intervention, childrencorrectly identified, on average, 75.3% of the safe water attitude pictograms. This perception of safe attitudes significantly increasedpost-intervention (p<0.001), with recognition of 86.4% of the correct behaviours. The overall water safety score also significantlyimproved by 22.7% after the intervention (p<0.001). CONCLUSIONS: The educational song is a resource to promote the learning of signals and concepts related to child drowningprevention.(AU)

Augmented reality training in basic life support with the help of smart glasses. A pilot study.

Introduction: Laypeople should be trained in basic life support and traditional and innovative methodologies may help to obtain this goal. However, there is a knowledge gap about the ideal basic life support training methods. Smart glasses could have a role facilitating laypeople learning of basic life support. Aim: To analyze the potential impact on basic life support learning of a very brief training supported by smart glasses video communication. Methods: Twelve laypeople were basic life support tele-trained by means of smart glasses by an instructor in this pilot study. During training (assisted trough smart glasses) and after the training (unassisted) participants' performance and quality of basic life support and automated external defibrillation procedure were assessed on a standardized simulated scenario. Results: After the training all participants were able to deliver good quality basic life support, with results comparable to those obtained when real time remotely guided by the instructor through the smart glasses. Mean chest compression rate was significantly higher when not guided (113 /min vs. 103 /min, p = 0.001). When not assisted, the participants spent less time delivering the sequential basic life support steps than when assisted while training. Conclusions: A very brief remote training supported by instructor and smart glasses seems to be an effective educational method that could facilitate basic life support learning by laypeople. This technology could be considered in cases where instructors are not locally available or in general in remote areas, providing basic internet connection is available. Smart glasses could also be useful for laypeople rolling-refreshers.

Would anti-choking devices be correctly and quickly managed by health science students? A manikin crossover trial.

BACKGROUND: The brand-new anti-choking devices (LifeVac® and DeCHOKER®) have been recently developed to treat Foreign Body Airway Obstruction (FBAO). However, the scientific evidence around these devices that are available to the public is limited. Therefore, this study aimed to assess the ability to use the LifeVac® and DeCHOKER® devices in an adult FBAO simulated scenario, by untrained health science students. METHODS: Forty-three health science students were asked to solve an FBAO event in three simulated scenarios: 1) using the LifeVac®, 2) using the DeCHOKER®, and 3) following the recommendations of the current FBAO protocol. A simulation-based assessment was used to analyze the correct compliance rate in the three scenarios based on the correct execution of the required steps, and the time it took to complete each one. RESULTS: Participants achieved correct compliance rates between 80-100%, similar in both devices (p = 0.192). Overall test times were significantly shorter with LifeVac® than DeCHOKER® device (36.6 sec. [31.9-44.4] vs. 50.4 s [36.7-66.9], p < 0.001). Regarding the recommended protocol, a 50% correct compliance rate was obtained in those with prior training vs. 31.3% without training, (p = 0.002). CONCLUSIONS: Untrained health science students are able to quickly and adequately use the brand-new anti-choking devices but have more difficulties in applying the current recommended FBAO protocol.

An effort to reduce chest compression pauses during automated external defibrillator use among laypeople: A randomized partially blinded controlled trial.

Aim: To implement small methodological changes in basic life support (BLS) training to reduce unnecessary pauses during automated external defibrillator (AED) use. Methods: One hundred and two university students with no BLS knowledge were randomly allocated into three groups (control and 2 experimental groups). Both experimental groups received a two-hour BLS training. While the contents were identical in both groups, in one of them the reduction of no-flow time was focused on (focused no-flow group). The control group did not receive any training. Finally, all of them were evaluated in the same out-of-hospital cardiac arrest simulated scenario. The primary endpoint was the compression fraction. Results: Results from 78 participants were analysed (control group: 19; traditional group: 30; focused no-flow group: 29). The focused no-flow group achieved higher percentages of compression fraction (median: 56.0, interquartile rank (IQR): 53.5-58.5) than the traditional group (44.0, IQR: 42.0-47.0) and control group (52.0, IQR: 43.0-58.0) in the complete scenario. Participants from the control group performed compression-only cardiopulmonary resuscitation (CPR), while the other groups performed compression-ventilation CPR. CPR fraction was calculated, showing the fraction of time in which the participants were performing resuscitation manoeuvres. In this case, the focused no-flow group reached higher percentages of CPR fraction (77.6, IQR: 74.4-82.4) than the traditional group (61.9, IQR: 59.3-68.1) and the control group (52.0, IQR: 43.0-58.0). Conclusions: Laypeople having automated external defibrillation training focused on acting in anticipation of the AED prompts contributed to a reduction in chest compression pauses during an OHCA simulated scenario.

Are smart glasses feasible for dispatch prehospital assistance during on-boat cardiac arrest? A pilot simulation study with fishermen.

The aim of the study was to explore feasibility of basic life support (BLS) guided through smart glasses (SGs) when assisting fishermen bystanders. Twelve participants assisted a simulated out-of-hospital cardiac arrest on a fishing boat assisted by the dispatcher through the SGs. The SGs were connected to make video calls. Feasibility was assessed whether or not they needed help from the dispatcher. BLS-AED steps, time to first shock/compression, and CPR's quality (hands-only) during 2 consecutive minutes (1st minute without dispatcher feedback, 2nd with dispatcher feedback) were analyzed. Reliability was analyzed by comparing the assessment of variables performed by the dispatcher through SGs with those registered by an on-scene instructor. Assistance through SGs was needed in 72% of the BLS steps, which enabled all participants to perform the ABC approach and use AED correctly. Feasibility was proven that dispatcher's feedback through SGs helped to improve bystanders' performance, as after dispatcher gave feedback via SGs, only 3% of skills were incorrect. Comparison of on-scene instructor vs. SGs assessment by dispatcher differ in 8% of the analyzed skills: greatest difference in the "incorrect hand position during CPR" (on-scene: 33% vs. dispatcher: 0%). When comparing the 1st minute with 2nd minute, there were only significant differences in the percentage of compressions with correct depth (1st:48 ± 42%, 2nd:70 ± 31, p = 0.02). Using SGs in aquatic settings is feasible and improves BLS. CPR quality markers were similar with and without SG. These devices have great potential for communication between dispatchers and laypersons but need more development to be used in real emergencies.

Microangiopatías trombóticas en niños críticamente enfermos. Registro español MATUCIP / Thrombotic microangiopathies in critically ill children: The MATUCIP registry in Spain

Introducción: Las microangiopatías trombóticas (MAT) son entidades infrecuentes que suelen causar afectación renal, hematológica, neurológica y cardiovascular, con síntomas inespecíficos pero graves. Con la finalidad de mejorar el conocimiento de sus características clínicas, el proceso diagnóstico y el tratamiento en la fase aguda, se ha creado el registro de MAT en las unidades de cuidados intensivos pediátricos (UCIP) de España (Registro MATUCIP). Pacientes y métodos: Estudio observacional, multicéntrico, realizado en 20 UCIP españolas desde enero de 2017 hasta diciembre de 2021 que incluyó niños mayores de 1mes con diagnóstico de MAT y seguimiento hasta el alta de la UCIP. Resultados: Se incluyeron 97 pacientes (51,5% mujeres), con una mediana de edad de 2,6años (RIQ: 1,6-5,7). La clínica inicial fue de tipo gastrointestinal (74,2%), respiratoria (14,4%), cuadro febril (5,2%), neurológica (3,1%) y otras (3,1%). Al ingreso, el 75,3% presentaban anemia hemolítica microangiopática, el 95,9% trombocitopenia y el 94,8% daño renal agudo. Fueron diagnosticados de síndrome hemolítico urémico (SHU) asociado a Escherichia coli productora de toxina Shiga el 57,7%, SHU por Streptococcus pneumoniae el 14,4%, SHU atípico el 15,6%, MAT secundaria el 10,3% y púrpura trombótica trombocitopénica el 2,1%. Desarrollaron hipertensión arterial el 89,7%, manifestaciones digestivas el 49,5%, respiratorias el 22,7%, neurológicas el 25,8% y cardiacas el 12,4%. El 60,8% requirieron depuración extrarrenal y el 2,1%, plasmaféresis. Recibieron eculizumab 20 pacientes. La mediana de estancia en la UCIP fue de 8,5días (RIQ: 5-16,5). Dos niños fallecieron. (AU)

Introduction: Thrombotic microangiopathies (TMA) are rare diseases usually presenting with renal, haematological, neurologic and cardiovascular involvement and nonspecific but severe symptoms. A registry of TMA cases managed in Spanish paediatric intensive care units (the MATUCIP registry) was established with the aim of gaining knowledge on their clinical characteristics, diagnosis and acute-phase treatment. Patients and methods: We conducted a prospective multicentre observational study in 20 paediatric intensive care units (PICUs) in Spain from January 2017 to December 2021 in children aged more than 1month with TMAs, who were followed up through the discharge from the PICU. Results: The sample included 97 patients (51.5% female) with a median age of 2.6years (interquartile range [IQR]: 1.6-5.7). The initial manifestations were gastrointestinal (74.2%), respiratory (14.4%), fever (5.2%), neurologic (3.1%) and other (3.1%). At admission, 75.3% of patients had microangiopathic haemolytic anaemia, 95.9% thrombocytopenia and 94.8% acute kidney injury. Of the total sample, 57.7% of patients received a diagnosis of Shiga toxin-associated haemolytic uraemic syndrome (HUS), 14.4% of Streptococcus pneumoniae-associated HUS, 15.6% of atypical HUS, 10.3% of secondary TMA and 2.1% of thrombotic thrombocytopenic purpura. Eighty-seven patients (89.7%) developed arterial hypertension, and 49.5% gastrointestinal, 22.7% respiratory, 25.8% neurologic and 12.4% cardiac manifestations. Also, 60.8% required renal replacement therapy and 2.1% plasma exchange. Twenty patients received eculizumab. The median PICU stay was 8.5days (IQR: 5-16.5). Two children died. (AU)

Thrombotic microangiopathies in critically ill children: The MATUCIP registry in Spain.

INTRODUCTION: Thrombotic microangiopathies (TMA) are rare diseases usually presenting with renal, haematological, neurologic and cardiovascular involvement and nonspecific but severe symptoms. A registry of TMA cases managed in Spanish paediatric intensive care units (the MATUCIP Registry) was established with the aim of gaining knowledge on their clinical characteristics, diagnosis and acute-phase treatment. METHODS: We conducted a prospective multicentre observational study in 20 paediatric intensive care units (PICUs) in Spain from January 2017 to December 2021 in children aged more than 1 month with TMAs, who were followed up through the discharge from the PICU. RESULTS: The sample included 97 patients (51.5% female) with a median age of 2.6 years (interquartile range [IQR], 1.6-5.7). The initial manifestations were gastrointestinal (74.2%), respiratory (14.4%), fever (5.2%), neurologic (3.1%) and other (3.1%). At admission, 75.3% of patients had microangiopathic haemolytic anaemia, 95.9% thrombocytopenia and 94.8% acute kidney injury. Of the total sample, 57.7% of patients received a diagnosis of Shiga toxin-associated haemolytic uraemic syndrome (HUS), 14.4% of Streptococcus pneumoniae-associated HUS, 15.6% of atypical HUS, 10.3% of secondary TMA and 2.1% of thrombotic thrombocytopenic purpura. Eighty-seven patients (89.7%) developed arterial hypertension, and 49.5% gastrointestinal, 22.7% respiratory, 25.8% neurologic and 12.4% cardiac manifestations. Also, 60.8% required renal replacement therapy and 2.1% plasma exchange. Twenty patients received eculizumab. The median PICU stay was 8.5 days (IQR, 5-16.5). Two children died. CONCLUSIONS: The MATUCIP registry demonstrates the clinical variability of TMA cases requiring admission to the PICU. Knowledge of the presentation and outcomes of TMAs can facilitate early aetiological diagnosis. This registry can help improve our understanding of the clinical spectrum of these diseases, for which there is a dearth of published data.