Resuscitation
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Multicenter Study Observational Study
SHOCKABLE RHYTHMS AND DEFIBRILLATION DURING IN-HOSPITAL PAEDIATRIC CARDIAC ARREST.
To analyze the results of cardiopulmonary resuscitation (CPR) that included defibrillation during in-hospital cardiac arrest (IH-CA) in children. ⋯ The termination of pediatric VF/pVT in the IH-CA setting is achieved in a low percentage of instances with one electrical shock at 4Jkg(-1). When VF/pVT is the first documented rhythm, the results of defibrillation are better than in the case of subsequent VF/pVT. No clear relationship between defibrillation protocol and ROSC or survival has been observed. The optimal pediatric defibrillation dose remains to be determined; therefore current resuscitation guidelines cannot be considered evidence-based, and additional research is needed.
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Randomized Controlled Trial
The impact of peri-shock pause on survival from out- of- hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial.
Previous research has demonstrated significant relationships between peri-shock pause and survival to discharge from out-of-hospital shockable cardiac arrest (OHCA). ⋯ In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses.
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Observational Study
Early microcirculatory impairment during therapeutic hypothermia is associated with poor outcome in post-cardiac arrest children: a prospective observational cohort study.
This study aimed to evaluate if the microcirculation is impaired during and after therapeutic hypothermia (TH) in children with return of spontaneous circulation after cardiac arrest (CA) and to assess if microcirculatory impairment predicts mortality. This has been reported for post-CA adults, but results might be different for children because etiology, pathophysiology, and mortality rate differ. ⋯ The microcirculation is impaired in post-CA children during TH and more severe impairment at TH start was associated with mortality. After the stop of TH, the microcirculation improves rapidly irrespective of outcome.
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Comparative Study Observational Study
A comparison of actual to estimated weights in Australian children attending a tertiary children's' hospital, using the original and updated APLS, Luscombe and Owens, Best Guess formulae and the Broselow tape.
During paediatric resuscitation it is essential to be able to estimate the child's weight as it determines drug doses and equipment sizes. Age and length-based estimations exist, with age-based estimations being especially useful in the preparation phase and the length-based Broselow tape having weight-based drug doses and equipment already assigned via a colour code system. The aim of this study was to compare the actual recorded weights of Australian children to the predicted weights using the original and updated APLS, Luscombe and Owens and Best Guess formulae and the Broselow tape. ⋯ For an age-based weight estimation, in infants less than one year the new APLS formula is the most accurate and over one year the Best Guess formulae should be used.
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Comparative Study
Decision-tree early warning score (DTEWS) validates the design of the National Early Warning Score (NEWS).
To compare the performance of a human-generated, trial and error-optimised early warning score (EWS), i.e., National Early Warning Score (NEWS), with one generated entirely algorithmically using Decision Tree (DT) analysis. ⋯ The decision-tree technique independently validates the composition and weightings of NEWS. The DT approach quickly provided an almost identical EWS to NEWS, although one that admittedly would benefit from fine-tuning using clinical knowledge. We believe that DT analysis could be used to quickly develop candidate models for disease-specific EWSs, which may be required in future.