Pediatric Basic Life Support(BLS) Prognosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{CMG}}; {{AE}} {{Neepa Shah}}  
{{CMG}}; {{AE}} {{Neepa Shah}}  
=='''Overview'''==
=='''Overview'''==
Pediatric Basic Life Support is a life-saving skill comprising of high quality [[CPR (Cardiopulmonary Resuscitation)]] and Rescue Breadths with [[Artificial External Defibrillator (AED)]].  
Pediatric Basic Life Support is a life-saving skill comprising of high quality [[CPR (Cardiopulmonary Resuscitation)]] and Rescue Breadths with [[Artificial External Defibrillator (AED)]].  
* Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all <ref name="pmid27837587">{{cite journal| author=Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA | display-authors=etal| title=Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. | journal=JAMA Pediatr | year= 2017 | volume= 171 | issue= 2 | pages= 133-141 | pmid=27837587 | doi=10.1001/jamapediatrics.2016.3643 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27837587 }} </ref> found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)
* Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all  found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)


* Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
* Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
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**The short interval between arrest and arrival at the hospital.
**The short interval between arrest and arrival at the hospital.
**Less than 20 minutes of resuscitation in the emergency department.
**Less than 20 minutes of resuscitation in the emergency department.
**Less than 2 doses of epinephrine.<ref name="pmid20930968">{{cite journal| author=Sahu S, Kishore K, Lata I| title=Better outcome after pediatric resuscitation is still a dilemma. | journal=J Emerg Trauma Shock | year= 2010 | volume= 3 | issue= 3 | pages= 243-50 | pmid=20930968 | doi=10.4103/0974-2700.66524 | pmc=2938489 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20930968 }}</ref>
**Less than 2 doses of epinephrine.
 
=='''References'''==
<references />
{{Reflist|2}}
 
{{WH}}
{{WS}}
[[Category: (Pediatrics)]]
 
==Prognosis==
The following tables provide the details of the different studies done to determine which factors during pediatric cardiac arrest [[CPR|resuscitation]] have a superior prognosis.
OHCA - Out of hospital cardiac arrest.
ROSC- Return of spontaneous circulation.
{| class="wikitable"
|+Summary of  studies for OHCA to determine age as a [[prognostic]] factor
!
! rowspan="2" |Age <1 year compared to >1 year
! rowspan="2" |Author
! rowspan="2" |Study details
|-
| rowspan="2" |30- Day survival with good neurological outcome
|-
|Good prognosis associated in children >1 year
| Tetsuhisa Kitamura, MD
|Study group - 5158 Children (RR -2.4; 95% CI,1.7-3.4)
|-
|30-Day survival in age >1 year
|Good prognosis associated in children >1 year
| Tetsuhisa Kitamura, MD <ref name="pmid20202679">{{cite journal| author=Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM | display-authors=etal| title=Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. | journal=Lancet | year= 2010 | volume= 375 | issue= 9723 | pages= 1347-54 | pmid=20202679 | doi=10.1016/S0140-6736(10)60064-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20202679  }} </ref>
|Study group- 5158 Children (RR- 1.5; 95% CI,1.3-1.8)
|-
| rowspan="3" |Survival to hospital discharge
|Good prognosis associated in children >1 year
|Dianne L. Atkins
|Study group- 621 Children (RR- 2.7; 95% CI,1.3-5.7)
|-
|Good prognosis associated in children >1 year
|Kelly D. Young
|Study group- 599 Children (RR- 1.3; 95% CI,0.8-2.1)
|-
|Good prognosis associated in children >1 year
|Moler, Frank W. MD
|Study group- 138 Children (RR- 1.4; 95% CI,0.8-2.4)
|}
{| class="wikitable"
|+Summary of  studies for OHCA to determine shockable rhythm vs non-shockable rhythm as a prognostic factor 
!
!Shockable rhythm vs non-Shockable rhythm
!Author
!Study details
|-
|30- Day survival with good neurological outcome
|Good prognosis with shockable rhythm like VF
|Tetsuhisa Kitamura, MD <ref name="pmid20202679">{{cite journal| author=Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM | display-authors=etal| title=Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. | journal=Lancet | year= 2010 | volume= 375 | issue= 9723 | pages= 1347-54 | pmid=20202679 | doi=10.1016/S0140-6736(10)60064-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20202679  }} </ref>
|Study group- 5170 Children (RR- 4.4; 95% CI,3.6-5.3)
|-
|30-Day survival 
|Good prognosis with shockable rhythm like VF
|Tetsuhisa Kitamura, MD <ref name="pmid20202679">{{cite journal| author=Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM | display-authors=etal| title=Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. | journal=Lancet | year= 2010 | volume= 375 | issue= 9723 | pages= 1347-54 | pmid=20202679 | doi=10.1016/S0140-6736(10)60064-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20202679  }} </ref>
|Study group- 5170 Children (RR- 9.0; 95% CI,6.7-12.3)
|-
| rowspan="2" |Survival to hospital discharge
|Good prognosis with shockable rhythm like VF
|Dianne L. Atkins <ref name="pmid19273724">{{cite journal| author=Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR | display-authors=etal| title=Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1484-91 | pmid=19273724 | doi=10.1161/CIRCULATIONAHA.108.802678 | pmc=2679169 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19273724  }} </ref>
|Study group- 366 Children (RR- 4.0; 95% CI,1.8-8.9)
|-
|Good prognosis with shockable rhythm like VF
|Moler, Frank W. MD<ref name="pmid20935561">{{cite journal| author=Moler FW, Donaldson AE, Meert K, Brilli RJ, Nadkarni V, Shaffner DH | display-authors=etal| title=Multicenter cohort study of out-of-hospital pediatric cardiac arrest. | journal=Crit Care Med | year= 2011 | volume= 39 | issue= 1 | pages= 141-9 | pmid=20935561 | doi=10.1097/CCM.0b013e3181fa3c17 | pmc=3297020 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20935561  }} </ref>
|Study group- 138 Children (RR- 2.7; 95% CI,1.3-5.6)
|}
=== Variables with the good prognostic outcome<ref name="pmid26472853">{{cite journal| author=de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM | display-authors=etal| title=Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. | journal=Circulation | year= 2015 | volume= 132 | issue= 16 Suppl 1 | pages= S177-203 | pmid=26472853 | doi=10.1161/CIR.0000000000000275 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472853 }} </ref> ===
*Age >1 year
*Shockable rhythm like [[ventricular fibrillation]]
*Less duration of [[CPR]]
*[[Pupillary reflex|Reactive pupil]] at 24 hours after [[ROSC]]
*Lower serum [[lactate]] levels at 0 to 12 hours after [[ROSC]] is associated with improved outcomes.


=='''References'''==
=='''References'''==

Latest revision as of 09:33, 11 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Neepa Shah, M.B.B.S.[2]

Overview

Pediatric Basic Life Support is a life-saving skill comprising of high quality CPR (Cardiopulmonary Resuscitation) and Rescue Breadths with Artificial External Defibrillator (AED).

  • Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)
  • Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
  • Good Prognostic Factor upon arrival at the emergency department-
    • The short interval between arrest and arrival at the hospital.
    • Less than 20 minutes of resuscitation in the emergency department.
    • Less than 2 doses of epinephrine.

References

Template:WH Template:WS

Prognosis

The following tables provide the details of the different studies done to determine which factors during pediatric cardiac arrest resuscitation have a superior prognosis. OHCA - Out of hospital cardiac arrest. ROSC- Return of spontaneous circulation.

Summary of studies for OHCA to determine age as a prognostic factor
Age <1 year compared to >1 year Author Study details
30- Day survival with good neurological outcome
Good prognosis associated in children >1 year Tetsuhisa Kitamura, MD Study group - 5158 Children (RR -2.4; 95% CI,1.7-3.4)
30-Day survival in age >1 year Good prognosis associated in children >1 year Tetsuhisa Kitamura, MD [1] Study group- 5158 Children (RR- 1.5; 95% CI,1.3-1.8)
Survival to hospital discharge Good prognosis associated in children >1 year Dianne L. Atkins Study group- 621 Children (RR- 2.7; 95% CI,1.3-5.7)
Good prognosis associated in children >1 year Kelly D. Young Study group- 599 Children (RR- 1.3; 95% CI,0.8-2.1)
Good prognosis associated in children >1 year Moler, Frank W. MD Study group- 138 Children (RR- 1.4; 95% CI,0.8-2.4)
Summary of studies for OHCA to determine shockable rhythm vs non-shockable rhythm as a prognostic factor
Shockable rhythm vs non-Shockable rhythm Author Study details
30- Day survival with good neurological outcome Good prognosis with shockable rhythm like VF Tetsuhisa Kitamura, MD [1] Study group- 5170 Children (RR- 4.4; 95% CI,3.6-5.3)
30-Day survival Good prognosis with shockable rhythm like VF Tetsuhisa Kitamura, MD [1] Study group- 5170 Children (RR- 9.0; 95% CI,6.7-12.3)
Survival to hospital discharge Good prognosis with shockable rhythm like VF Dianne L. Atkins [2] Study group- 366 Children (RR- 4.0; 95% CI,1.8-8.9)
Good prognosis with shockable rhythm like VF Moler, Frank W. MD[3] Study group- 138 Children (RR- 2.7; 95% CI,1.3-5.6)

Variables with the good prognostic outcome[4]

References

  1. ↑ 1.0 1.1 1.2 Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM; et al. (2010). "Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study". Lancet. 375 (9723): 1347–54. doi:10.1016/S0140-6736(10)60064-5. PMID 20202679.
  2. ↑ Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR; et al. (2009). "Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest". Circulation. 119 (11): 1484–91. doi:10.1161/CIRCULATIONAHA.108.802678. PMC 2679169. PMID 19273724.
  3. ↑ Moler FW, Donaldson AE, Meert K, Brilli RJ, Nadkarni V, Shaffner DH; et al. (2011). "Multicenter cohort study of out-of-hospital pediatric cardiac arrest". Crit Care Med. 39 (1): 141–9. doi:10.1097/CCM.0b013e3181fa3c17. PMC 3297020. PMID 20935561.
  4. ↑ de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM; et al. (2015). "Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation. 132 (16 Suppl 1): S177–203. doi:10.1161/CIR.0000000000000275. PMID 26472853.

Template:WH Template:WS

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