Resuscitation
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Patients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus daytime. ⋯ In this cohort of pediatric ICU patients with IHCA, there was no significant difference in DBP during CPR between nighttime and daytime.
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In hospital cardiac arrests occur at a rate of 1-5 per 1000 admissions and are associated with significant morbidity and mortality. We aimed to investigate the association between deviations from ACLS protocol and patient outcomes. ⋯ Our findings highlight the importance of adherence to the ACLS protocol. We found that deviations from the algorithm are associated with decreased rates of ROSC and survival to discharge. Additionally, higher rates of protocol deviations may be associated with higher rates of neurological impairments after cardiac arrest.
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The American Heart Association (AHA) recommends first defibrillation energy dose of 2 Joules/kilogram (J/kg) for pediatric cardiac arrest with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, optimal first energy dose remains unclear.
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The ECG is a critical diagnostic tool for the management of immediate sudden cardiac arrest (SCA) survivors, but can be altered as a consequence of the SCA event. A limited number of studies report that electrical remodeling post SCA is due to prolonged myocardial repolarization, but a better understanding of this phenomenon is needed. ⋯ Contrary to expectations, electrical remodeling of the ECG due to SCA occurs due to prolongation of ventricular depolarization (QRSD), and not repolarization (JTc). Prolonged QRSD may also assist with prognostication and warrants further evaluation.
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Observational Study
Analysis of Visual Attention and Team Communications during Neonatal Endotracheal Intubations using Eye-tracking: An Observational Study.
Eye-tracking can be used to analyse visual attention (VA) of health care providers during clinical tasks. No study has examined eye-tracking during neonatal endotracheal intubation. We aimed to examine VA and team communications during endotracheal intubation using eye-tracking in the Neonatal Intensive Care Unit. ⋯ During neonatal intubations, 50% of VA was directed away from the infant. Team communications were non-standard. Eye-tracking can be used to analyse human performance during neonatal resuscitation.