Radiological assessment of the paediatric chest: Need for revising current guidelines for chest...
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Posters S67 AP-086 Pediatrics out of hospital cardiac arrest survival J.M. Navalpotro Pascual, A.A. Mateos Rodr´ ıguez Emergency Medical Service of Madrid, SUMMA112, Spain Introduction: To describe the epidemiology of paediatric out-of- hospital cardiac arrest in Madrid and survival to hospital arrival. Methods: Retrospective observational study between January 2002 and December 2003, of 582 CPR attempts. Results: There were 18 paediatric cases (3.1% of total cardiac arrests). Six (33.3%) had ROSC on hospital arrival. 66.7% were male. 76.5% had bradycardia or asystole and 23.5% VF/pulseless VT. Sur- vival was 75% for VF/pulseless VT and 23.1% for bradycardia or asystole. In 22.2% of case clinical staff were present and in 33.3% there were no witnesses. The survival when sanitary staff witnessed the cardiac arrest was 50%, and for the group in which not-sanitary persons were present were less than 25% and when there was no witness was 33%. Survival if resuscitation started before the arrival of the emergency unit was 38.5% compared with 0% if this did not occur. Most cardiac arrests in our series were caused by trauma. Conclusion: Out-of-hospital cardiac arrest is less common in children compared to adults. The overall survival rate is better in children than adults. When CPR was not started before the arrival of the emergency services there were no survivors. If cardiac arrest occurred in the presence of the emergency service, survival improved. Survival was best in trauma patients. doi:10.1016/j.resuscitation.2008.03.205 AP-087 Radiological assessment of the paediatric chest: Need for revising current guidelines for chest compression? Pei-Chieh Kao, Wen-Chu Chiang, Chi-Wei Yang, Yueh-Ping Liu, Chien-Chang Lee, Chow-In Ko Patrick, Shyh-Jye Chen, Shyr-Chyr Chen, Matthew Huei-Ming Ma Emergency Medicine, National Taiwan University Hospital, Taiwan Introduction: The current guidelines on neonatal and paedi- atric resuscitation recommend a compression depth of 1/3 to 1/2 of the anterior—posterior chest diameter (APD). However, there has been little evidence supporting such manoeuvre. This study was conducted to assess the actual depth of chest compressions in neonatal and paediatric populations if current guidelines are strictly followed. Methods: Chest computerised tomography (CT) of 12 neonatal (<1 year of age) and 11 paediatric (1—8 years of age) patients were reviewed. Measurements of AP diameter of chest CT scans (APD) were taken from the skin anteriorly perpendicularly to the skin on the posterior thorax at either the inter-nipple line (INL) or the middle of the lower half of sternum (LS). Results: In the neonatal group, there were 10 male infants with the mean age was 0.39 years. In the paediatric group, there were 7 male children with a mean age of 4.36 years. Our measurements showed that compression depth would be equal to or greater than the recommended depth for adult chest compression (3.8—5.1 cm) if current guidelines are followed. No difference in compression depth was found whether distance was measured at INL or LS (see Table 1). Table 1 Location Neonatal (N = 12) Paediatric (N = 11) INL LS INL LS APD (cm) 10.2 ± 1.0 10.3 ± 1.2 13.2 ± 1.1 13.2 ± 1.1 1/3 APD (cm) 0.4 ± 0.3 3.4 ± 0.4 4.4 ± 0.4 4.4 ± 0.4 1/2 APD(cm) 5.1 ± 0.5 5.1 ± 0.6 6.6 ± 0.6 6.6 ± 0.6 Conclusions: Measurements made from radiological assessments of the neonatal and paediatric chest indicate similar or higher depths of compression for neonatal and paediatric populations when compared with the adult populations according to current guide- lines. More evidence is needed to provide a more realistic guide to the depth of chest compression in the neonatal and paediatric populations. Reference 1. 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emer- gency Cardiovascular Care Science with Treatment Recommendations. Part 3. Overview of CPR. Circulation 2005;112(Suppl. I): IV—12. doi:10.1016/j.resuscitation.2008.03.206 POST RESUSCITATION CARE AP-088 An observational cohort study on outcomes of patients admitted to intensive care unit following cardiac arrest N. Davis-Gomez, T. Melody, L. Jiang, G.D. Perkins, F. Gao Academic Department Anaesthesia, Critical Care and Pain Research, Birmingham Heartlands Hospital, UK Introduction: Approximately 80% of survivors of cardiac arrest are comatose following return of spontaneous circulation and may be eligible for ICU admission. This study sought to establish long- term outcomes (and predictors of outcome) in comatose survivors of cardiac arrest admitted to ICU. Methods: Adult patients, admitted to ICU between 1996 and 2004, who had CPR within 24 h prior to ICU admission, were identi- fied from the ICU database (ICNARC). Demographic and physiological parameters within 24 h of admission were collected. Organ failure was defined by SOFA score. Short-term (survival) and long-term outcomes (Karnofsky Performance Scores (KPS)) were recorded. Multiple logistic regression was used to identify factors associated with poor outcome. Results: 424 cardiac arrest survivors were admitted to ICU out of 5298 total admissions (8%). ICU and hospital survival rates was 41% (n = 174) and 25% (n =107), respectively, compared to survival rates of 73% and 64% in all patients (p < 0.001). Organ failure was common after admission (respiratory 54%; CVS 39%; renal 16%). 35% had hyperglycaemia (BM > 11.1). Patients with ≥2 organ fail- ure had a sixfold increase in hospital mortality (OR 6.8; 95% CI 4.4—10). APACHE 2, age; gender did not predict outcome. Most patients discharged from hospital were alive at 1 (80%) and 2 years (69%). The working age group (<65 years) comprised 18 patients, median age 44.5 years (IQR 30—51). 1/3 were unable to return to work. Median KPS was 75. The non-working age group, (≥65 years) included 16 patients, median age 69 years (IQR 65—76). Median KPS was 95. Discussion: Patients who develop multi-organ failure within 24 h of admission to ICU are at increased risk of death. Most patients that survive to hospital discharge are alive at 1 year. There is high morbidity in young survivors and a third were unable to return to work. References 1. Peberdy MA, For the NRCPR Investigators. Cardiopulmonary resuscitation of adults in the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopul- monary Resuscitation. Resuscitation 2003;58:297—308. 2. Vincent JL, Moreno R, Takala J, et al., On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive care Medicine. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707—10.
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Transcript of Radiological assessment of the paediatric chest: Need for revising current guidelines for chest...
Posters
AP-086Pediatrics out of hospital cardiac arrest survival
J.M. Navalpotro Pascual, A.A. Mateos Rodrıguez
Emergency Medical Service of Madrid, SUMMA112, Spain
Introduction: To describe the epidemiology of paediatric out-of-hospital cardiac arrest in Madrid and survival to hospital arrival.
Methods: Retrospective observational study between January2002 and December 2003, of 582 CPR attempts.
Results: There were 18 paediatric cases (3.1% of total cardiacarrests). Six (33.3%) had ROSC on hospital arrival. 66.7% were male.76.5% had bradycardia or asystole and 23.5% VF/pulseless VT. Sur-vival was 75% for VF/pulseless VT and 23.1% for bradycardia orasystole. In 22.2% of case clinical staff were present and in 33.3%there were no witnesses. The survival when sanitary staff witnessedthe cardiac arrest was 50%, and for the group in which not-sanitarypersons were present were less than 25% and when there was nowitness was 33%. Survival if resuscitation started before the arrivalof the emergency unit was 38.5% compared with 0% if this did notoccur. Most cardiac arrests in our series were caused by trauma.
Conclusion: Out-of-hospital cardiac arrest is less common inchildren compared to adults. The overall survival rate is betterin children than adults. When CPR was not started before thearrival of the emergency services there were no survivors. If cardiacarrest occurred in the presence of the emergency service, survivalimproved. Survival was best in trauma patients.
doi:10.1016/j.resuscitation.2008.03.205
AP-087Radiological assessment of the paediatric chest: Need forrevising current guidelines for chest compression?
Pei-Chieh Kao, Wen-Chu Chiang, Chi-Wei Yang,Yueh-Ping Liu, Chien-Chang Lee, Chow-In Ko Patrick,Shyh-Jye Chen, Shyr-Chyr Chen, Matthew Huei-Ming Ma
Emergency Medicine, National Taiwan University Hospital, Taiwan
Introduction: The current guidelines on neonatal and paedi-atric resuscitation recommend a compression depth of 1/3 to 1/2of the anterior—posterior chest diameter (APD). However, therehas been little evidence supporting such manoeuvre. This studywas conducted to assess the actual depth of chest compressions inneonatal and paediatric populations if current guidelines are strictlyfollowed.
Methods: Chest computerised tomography (CT) of 12 neonatal(<1 year of age) and 11 paediatric (1—8 years of age) patients werereviewed. Measurements of AP diameter of chest CT scans (APD)were taken from the skin anteriorly perpendicularly to the skinon the posterior thorax at either the inter-nipple line (INL) or themiddle of the lower half of sternum (LS).
Results: In the neonatal group, there were 10 male infants withthe mean age was 0.39 years. In the paediatric group, there were7 male children with a mean age of 4.36 years. Our measurementsshowed that compression depth would be equal to or greater thanthe recommended depth for adult chest compression (3.8—5.1 cm)if current guidelines are followed. No difference in compressiondepth was found whether distance was measured at INL or LS (seeTable 1).
Table 1Location Neonatal (N = 12) Paediatric (N = 11)
INL LS INL LSAPD (cm) 10.2 ± 1.0 10.3 ± 1.2 13.2 ± 1.1 13.2 ± 1.11/3 APD (cm) 0.4 ± 0.3 3.4 ± 0.4 4.4 ± 0.4 4.4 ± 0.41/2 APD(cm) 5.1 ± 0.5 5.1 ± 0.6 6.6 ± 0.6 6.6 ± 0.6
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Conclusions: Measurements made from radiological assessmentsf the neonatal and paediatric chest indicate similar or higherepths of compression for neonatal and paediatric populations whenompared with the adult populations according to current guide-ines. More evidence is needed to provide a more realistic guideo the depth of chest compression in the neonatal and paediatricopulations.
eference
. 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emer-gency Cardiovascular Care Science with Treatment Recommendations. Part 3. Overviewof CPR. Circulation 2005;112(Suppl. I): IV—12.
oi:10.1016/j.resuscitation.2008.03.206
OST RESUSCITATION CARE
P-088n observational cohort study on outcomes of patientsdmitted to intensive care unit following cardiac arrest
. Davis-Gomez, T. Melody, L. Jiang, G.D. Perkins, F. Gao
Academic Department Anaesthesia, Critical Care and Painesearch, Birmingham Heartlands Hospital, UK
Introduction: Approximately 80% of survivors of cardiac arrestre comatose following return of spontaneous circulation and maye eligible for ICU admission. This study sought to establish long-erm outcomes (and predictors of outcome) in comatose survivorsf cardiac arrest admitted to ICU.
Methods: Adult patients, admitted to ICU between 1996 and004, who had CPR within 24 h prior to ICU admission, were identi-ed from the ICU database (ICNARC). Demographic and physiologicalarameters within 24 h of admission were collected. Organ failureas defined by SOFA score. Short-term (survival) and long-termutcomes (Karnofsky Performance Scores (KPS)) were recorded.ultiple logistic regression was used to identify factors associatedith poor outcome.
Results: 424 cardiac arrest survivors were admitted to ICU outf 5298 total admissions (8%). ICU and hospital survival rates was1% (n = 174) and 25% (n = 107), respectively, compared to survivalates of 73% and 64% in all patients (p < 0.001). Organ failure wasommon after admission (respiratory 54%; CVS 39%; renal 16%).5% had hyperglycaemia (BM > 11.1). Patients with ≥2 organ fail-re had a sixfold increase in hospital mortality (OR 6.8; 95% CI.4—10). APACHE 2, age; gender did not predict outcome. Mostatients discharged from hospital were alive at 1 (80%) and 2 years69%). The working age group (<65 years) comprised 18 patients,edian age 44.5 years (IQR 30—51). 1/3 were unable to return toork. Median KPS was 75. The non-working age group, (≥65 years)
ncluded 16 patients, median age 69 years (IQR 65—76). Median KPSas 95.
Discussion: Patients who develop multi-organ failure within 24 hf admission to ICU are at increased risk of death. Most patientshat survive to hospital discharge are alive at 1 year. There is highorbidity in young survivors and a third were unable to return toork.
eferences
. Peberdy MA, For the NRCPR Investigators. Cardiopulmonary resuscitation of adults in
the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopul-monary Resuscitation. Resuscitation 2003;58:297—308.. Vincent JL, Moreno R, Takala J, et al., On behalf of the Working Group on Sepsis-RelatedProblems of the European Society of Intensive care Medicine. The SOFA (Sepsis-relatedOrgan Failure Assessment) score to describe organ dysfunction/failure. Intensive CareMed 1996;22:707—10.
