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Chest compressions for pediatric organized rhythms: A hemodynamic and outcomes analysis.
Zinna, Shairbanu S; Morgan, Ryan W; Reeder, Ron W; Ahmed, Tageldin; Bell, Michael J; Bishop, Robert; Bochkoris, Matthew; Burns, Candice; Carcillo, Joseph A; Carpenter, Todd C; Cooper, Kellimarie K; Michael Dean, J; Wesley Diddle, J; Federman, Myke; Fernandez, Richard; Fink, Ericka L; Franzon, Deborah; Frazier, Aisha H; Friess, Stuart H; Graham, Kathryn; Hall, Mark; Harding, Monica L; Hehir, David A; Horvat, Christopher M; Huard, Leanna L; Landis, William P; Maa, Tensing; Manga, Arushi; McQuillen, Patrick S; Meert, Kathleen L; Mourani, Peter M; Nadkarni, Vinay M; Naim, Maryam Y; Notterman, Daniel; Pollack, Murray M; Sapru, Anil; Schneiter, Carleen; Sharron, Matthew P; Srivastava, Neeraj; Tilford, Bradley; Viteri, Shirley; Wessel, David; Wolfe, Heather A; Yates, Andrew R; Zuppa, Athena F; Berg, Robert A; Sutton, Robert M.
Afiliação
  • Zinna SS; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Morgan RW; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Reeder RW; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Ahmed T; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
  • Bell MJ; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Bishop R; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
  • Bochkoris M; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Burns C; Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA.
  • Carcillo JA; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Carpenter TC; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
  • Cooper KK; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Michael Dean J; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Wesley Diddle J; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Federman M; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Fernandez R; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Fink EL; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Franzon D; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Frazier AH; Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
  • Friess SH; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • Graham K; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Hall M; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Harding ML; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Hehir DA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Horvat CM; Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
  • Huard LL; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Landis WP; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Maa T; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Manga A; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
  • McQuillen PS; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA.
  • Meert KL; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
  • Mourani PM; University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
  • Nadkarni VM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Naim MY; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Notterman D; Department of Molecular Biology, Princeton University, Princeton, NJ, USA.
  • Pollack MM; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Sapru A; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Schneiter C; Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
  • Sharron MP; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Srivastava N; Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
  • Tilford B; Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA.
  • Viteri S; Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE, USA.
  • Wessel D; Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
  • Wolfe HA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Yates AR; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
  • Zuppa AF; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Berg RA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
  • Sutton RM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: suttonr@chop.edu.
Resuscitation ; 194: 110068, 2024 Jan.
Article em En | MEDLINE | ID: mdl-38052273
ABSTRACT

AIM:

Pediatric cardiopulmonary resuscitation (CPR) guidelines recommend starting CPR for heart rates (HRs) less than 60 beats per minute (bpm) with poor perfusion. Objectives were to (1) compare HRs and arterial blood pressures (BPs) prior to CPR among patients with clinician-reported bradycardia with poor perfusion ("BRADY") vs. pulseless electrical activity (PEA); and (2) determine if hemodynamics prior to CPR are associated with outcomes. METHODS AND

RESULTS:

Prospective observational cohort study performed as a secondary analysis of the ICU-RESUScitation trial (NCT028374497). Comparisons occurred (1) during the 15 seconds "immediately" prior to CPR and (2) over the two minutes prior to CPR, stratified by age (≤1 year, >1 year). Poisson regression models assessed associations between hemodynamics and outcomes. Primary outcome was return of spontaneous circulation (ROSC). Pre-CPR HRs were lower in BRADY vs. PEA (≤1 year 63.8 [46.5, 87.0] min-1 vs. 120 [93.2, 150.0], p < 0.001; >1 year 67.4 [54.5, 87.0] min-1 vs. 100 [66.7, 120], p < 0.014). Pre-CPR pulse pressure was higher among BRADY vs. PEA (≤1 year (12.9 [9.0, 28.5] mmHg vs. 10.4 [6.1, 13.4] mmHg, p > 0.001). Pre-CPR pulse pressure ≥ 20 mmHg was associated with higher rates of ROSC among PEA (aRR 1.58 [CI95 1.07, 2.35], p = 0.022) and survival to hospital discharge with favorable neurologic outcome in both groups (BRADY aRR 1.28 [CI95 1.01, 1.62], p = 0.040; PEA aRR 1.94 [CI95 1.19, 3.16], p = 0.008). Pre-CPR HR ≥ 60 bpm was not associated with outcomes.

CONCLUSIONS:

Pulse pressure and HR are used clinically to differentiate BRADY from PEA. A pre-CPR pulse pressure >20 mmHg was associated with improved patient outcomes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Reanimação Cardiopulmonar / Parada Cardíaca Limite: Child / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Reanimação Cardiopulmonar / Parada Cardíaca Limite: Child / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article