- Email: [email protected]
Relationship between hyperoxia after cardiopulmonary resuscitation and survival in cardiac arrest in-hospital paediatric patients
Abstracts / Resuscitation 81S (2010) S1–S114 VF/VT
PEA
tROSC
Without adrenaline (71 patients) Asystole 17 0 VF/VT 1 5 PEA 39 34 tROSC 0 4
Dead
Asystole
3 0 8 0
21 4 0 0
1 0 3 0
sROSC 1 1 12 0
With adrenaline (103 patients) Asystole 18 0 VF/VT 6 17 PEA 46 64 tROSC 0 4
6 0 32 9
57 19 0 39
1 4 47 0
3 1 29 0
tROSC, temporary ROSC; VF/VT, ventricular fibrillation/tachycardia, e.g. eight transitions from PEA to VF/VT occurred in the group without adrenaline compared to 32 in the adrenaline group. Conclusions: Adrenaline has notable effect on resuscitation from PEA, by “speeding up” the dynamics and extending the time window for sROSC to develop. Effects on long-term survival merit further investigation.
S3
ferent in-hospital cooling procedures (single blind randomization) in a multicenter trial (NCT00392639): endovascular using the femoral “CoolGard” device (AlsiusTM ) (ENDO) or external using fans and conventional ice packs (EXT). Results: No statistical difference was observed between the 203 ENDO patients and the 197 EXT patients regarding age, gender, previous co-morbidities, witnessed CA (92%), bystander cardiopulmonary resuscitation (54%), first rhythm for bystander or firemen (shockable rhythm 68%), first medical documented pre-hospital rhythm (ventricular tachycardia 10%, ventricular fibrillation 38%, asystole 38%, pulseless electrical activity 6%), pre- and initial in-hospital temperature, total epinephrine bolus doses. Time to target temperature (33 ◦ C) was significantly shorter in the ENDO group (p < 0.0001). Survival at discharge was similar between the ENDO and EXT groups (42.1 vs 38.1%). Survival without major neurological damages at day 28 (CPC1-2: primary endpoint) was not significantly different [p = 0.11, odds ratio = 1.18 (0.97–1.43)], however with a trend for a better outcome at day 90 (secondary endpoint) in the ENDO group (CPC1-2: 34.8%, 65 patients vs 26.0%, 47 patients, p = 0.067). Conclusion: The use of endovascular cooling for CA patients is not harmful and may have mid-term neuroprotective effects. doi:10.1016/j.resuscitation.2010.09.024
Reference 1. Olasveengen TM, et al. JAMA 2009;302:2222–9. doi:10.1016/j.resuscitation.2010.09.022
Arrhythmias AS009
AS007
Relationship between recurrences of ventricular fibrillation induced by chest compression with outcome in patients with out-of-hospital cardiac arrest
A randomised placebo controlled trial of adrenaline in cardiac arrest—The PACA trial
Aschieri D., Pelizzoni V., Cavanna A., Arvedi M., Nani S., Villani G.Q., Capucci A.
Jacobs I. 1 , Finn J. 2 , Jelinek G. 3 , Oxer H. 4 , Thompson P. 5
Cardiology, Guglielmo Da Saliceto Hospital Piacenza, Italy
1 Discipline
Successful defibrillation may be followed by recurrent ventricular fibrillation (rVF) in out-of-hospital cardiac arrest. It is still unclear whether rVF may influence survival. Purpose: The aim was to determine the relationship between rVF and survival. This is a retrospective study of out-of-hospital cardiac arrest recorded in the city of Piacenza, Italy, where a lay responders project of early defibrillation called “Progetto Vita” was organized. Material and methods: rVF were identified by analyzing the available ECGs from the automated external defibrillators used during cardiac arrest resuscitation attempts. In our study the ECG analysis was supported by the audio recording of rescuers voice during the intervention. The voice of rescuers was used for guiding us to identify the beginning of chest compression (CC) even when the signals were difficult to be interpreted. We calculated the survival rate at hospital discharge without neurologic damage and the mean time to first shock in pts with and without rVF. Results: 160 consecutive patients (pts) had a good quality ECG recordings and were considered for the analysis. Among the 160 pts, 96/160 pts had at least a rVF after the first successful shock (60%): 56/96 rVF (58%) were CC-related and 40/96 (42%) were spontaneous. 64/160 pts (40%) had no rVF after the first successful shock. Pts with no rVF had an higher survival rate compared to pts with rVF post-shock (27/64 = 42% vs 22/96 = 23%).
of Emergency Medicine; University of Western Australia School of Nursing and Midwifery; University of South Australia 3 Dept of Medicine; University of Melbourne 4 St John Ambulance; Western Australia 5 Western Australian Institute for Medical Research, University of Western Australia 2
Background: Adrenaline (epinephrine) remains the primary pharmacological agent in cardiac arrest. Despite a total absence of any experimental trials to establish efficacy, adrenaline is considered standard of care in resuscitation. Methods: A double-blind randomised placebo controlled trial of adrenaline in out-ofhospital cardiac arrest in Perth, Western Australia between August 2006 and November 2009. Patients randomly assigned to receive 1 ml aliquots of adrenaline 1:1000 or sodium chloride (0.9%). Primary outcome was survival to hospital discharge and secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome (Cerebral Performance Category Score). Odds ratios (OR) and 95% confidence intervals were derived and analysis was on an intention to treat basis. Results: 4107 cardiac arrests of which resuscitation was commenced in 1586 (38.6%) patients. Of these 602 (37.9%) were enrolled into the study with a further 67 (11.1%) being excluded after randomisation. Of the remaining 535 patients 262 (48.9%) and 273 (51.0%) received placebo or adrenaline respectively. The percentage male (70.6% versus 74.8%); mean age (64.8 versus 65.4 years) and percentage of patients who received bystander CPR (55.7% versus 53.1%) were similar for the adrenaline and placebo groups respectively. ROSC was achieved in 83 (30.4%) patients receiving adrenaline and 29 (11.1%) receiving placebo OR = 3.51 [95% CI: 2.21–5.58]. Survival to hospital discharge occurred in 11 (4.1%) and 5 (1.9%) of the adrenaline and placebo patients respectively OR = 2.16 [95% CI: 0.74–6.30] Conclusion: Adrenaline in cardiac arrest was associated with a significant increase in the proportion of patients achieving ROSC however not survival to hospital discharge. As these results are unable to rule out a clinically meaningful benefit of adrenaline in terms of survival to hospital discharge, further investigation into the post resuscitation period for those achieving ROSC is required in order to identify management strategies to improve survival. doi:10.1016/j.resuscitation.2010.09.023
doi:10.1016/j.resuscitation.2010.09.025
Paediatric Life Support AS010 Relationship between hyperoxia after cardiopulmonary resuscitation and survival in cardiac arrest in-hospital paediatric patients del Castillo J. 1,2 , López-Herce J. 1,2 , European and Latinoamerican Study Group of Cardiac Arrest in Children 1
Post Resuscitation Care AS008 Interest of endovascular cooling after cardiac arrest Deye N., The ICEREA Study Group Medical ICU, Lariboisiere Hospital, APHP, Paris, France Purpose: Therapeutic hypothermia is recommended for resuscitated cardiac arrest (CA) patients. Whether external or internal cooling is superior or not remains unknown. The aim of this study was to evaluate the interest of endovascular versus external cooling after CA. Methods: Inclusion criteria: age 18–79 years; out-of-hospital CA related to a presumed cardiac aetiology; delay between CA and return of spontaneous circulation (ROSC) <60 min; delay between ROSC and starting cooling <240 min; patient not obeying verbal command after ROSC and prior to start cooling. Non-inclusion criteria: do not reanimate order or terminal disease before inclusion; known pregnancy; clinical hemorrhagic syndrome; known coagulopathy; hypothermia at admission <30 ◦ C; extra-cardiac aetiology of the CA; in-hospital CA; refractory shock. Patients were randomized between two dif-
2
Pediatric Intensive Care Unit, Gregorio Mara˜ non Hospital, Madrid, Spain Red Iberoamericana de Estudio de la Parada Cardiaca en la Infancia
Purpose: Previous investigations have associated arterial hyperoxia in patients following cardiopulmonary resuscitation (CPR) with an increased mortality. To test the hypothesis that postresuscitation hyperoxia is associated with increased mortality in paediatric in-hospital cardiac arrests (CA). Patients and method: a prospective, international, observational, multicentric study was performed in 124 hospitals from 16 European and latinoamerican countries. CA in children between 1 month and 18 years were analysed using the Utstein template. Hyperoxia was defined as PaO2 of 300 mmHg or greater or a ratio of PaO2 to fraction inspired oxygen (PaO2 /FiO2 ) >300; hypoxia, PaO2 of less than 60 mmHg or a ratio of PaO2 to fraction inspired oxygen Results: 543 CA episodes were studied. 214 had arterial blood values registered immediately after return of spontaneous circulation (ROSC) and 170 patients 24 h after. After ROSC, the hyperoxia group (14/36: 39.9%) had lower mortality than the hypoxia group (62/133: 46.6%), but higher than the normoxia group (8/25: 32%) according PaO2 /FiO2 criteria, but it did not reach statistical signification (p = 0.34). According to PaO2 criteria, mortality was lower in the hyperoxia group (5/14: 35.7%) than the normoxia group (57/140: 40.7%) and the hypoxia group (25/51: 49%) (p = 0.51). 24 h after ROSC, mortality rate was higher in the hyperoxia group (1/2: 50%) than in the hypoxia group (63/151: 41.7%), but lower than the normoxia group (2/3: 66.7%) according to PaO2 /FiO2 criteria. The differences were not statistically significant (p = 0.67). According PaO2 criteria mor-
S4
Abstracts / Resuscitation 81S (2010) S1–S114
tality was higher amongst the hyperoxia group (1/3: 33.3%) than in the normoxia (45/138: 32.6%) and hypoxia (10/25: 40%) groups (p = 0.78). Conclusions: In children following CPR after in-hospital CA, arterial hyperoxia is rare and is not associated with an increase in mortality when compared to normoxia or hypoxia.
Epidemiology & Outcome AS013 Health-related quality of life after a drowning incident as a child
doi:10.1016/j.resuscitation.2010.09.026
Suominen P. 1 , Roine R. 2
Newborn Life Support
1 Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki, Finland 2 Administration, Helsinki and Uusimaa Hospital District, Helsinki, Finland
AS011 Analysis of inflation breaths during face mask resuscitation in preterm infants Murthy V. 1 , Fox G.F. 2 , Campbell M.E. 2 , Milner A. 1 , Greenough A. 1 1 School of Medicine, Division of Asthma, Allergy and Lung Biology, King’s College London, UK 2
Evelina Children’s Hospital Neonatal Unit, St Thomas’ Hospital, London, UK
Purpose of the study: Positive pressure ventilation with a prolonged inspiratory time is recommended to establish a functional residual capacity and deliver appropriate tidal volume at preterm resuscitation. The aim of the study was to analyse the peak inspiratory pressure (PIP), tidal volume (TV), inspiratory time (Ti) and face mask leak during the first five inflation breaths at preterm resuscitation. Patient and methods: The study used respiratory function monitor (NM3, Respironics) and a computer laptop with recording and analysis software (Spectra, Groove medical, UK) to analyse the flow, pressure and volume traces. The monitoring equipment recorded data at resuscitation of preterm infants born before 34 weeks of gestation. The study was conducted between March and July 2010 at King’s College Hospital, London. Clinicians involved in preterm resuscitation were trained and certified in newborn life support (Resuscitation council, UK). Parental consent was obtained for analysis of the data and the study was approved by Outer North London ethics committee. Results: A total of 100 inflation breaths from 21 preterm resuscitations were analysed. Median peak inspiratory pressure (PIP) was 25.1; range 19.7–38 cm H2 O, expired tidal volume (TVe) was 3.3 ml/kg; range 0.2–19.8 ml/kg, face mask leak was 43.1%; range 1–96%, inspiratory time was 1.1 s; range 0.2–3.2 s. Face mask leak was calculated from the inspired and expired tidal volume. Significant correlation was noted between PIP and TVe (r = 0.36). Conclusion: Inspiratory time achieved during the first five inflation breaths at preterm resuscitation is significantly lower than that recommended (2–3 s) by the resuscitation council. Using longer inspiratory times and minimising face mask leak may help to achieve optimal tidal volumes during preterm resuscitation. doi:10.1016/j.resuscitation.2010.09.027
Purpose of the study: To describe the health-related quality of life (HRQoL) and qualityadjusted life years (QALYs) in children and adults who had received cardiopulmonary resuscitation (CPR) after a drowning incident as a child. Materials and methods: Altogether 64 drowned children were admitted to the pediatric intensive care unit (PICU) of the Hospital for Children and Adolescents after successful CPR between 1985 and 2007. Eleven patients died in the PICU and 9 other patients within 6 months from the incident. In 2009 all the 44 long-term survivors, except 2, lived at home. Of the 42 patients who’s address could be located, 29 (69%) responded to a questionnaire. Depending on the age of the patients, HRQoL was assessed with the generic 15D questionnaire, or the versions developed for adolescents (16D) or children (17D), and compared to that of the general population. Incremental QALYs were calculated assuming that without treatment the patients would have died and that the reported HRQoL would remain constant from one year from the incident to the remaining statistical life expectancy of each patient. Results: The median age of the respondents was 17.0 (range 2–28) years and 62% of them were male. At the time of the drowning incident their median age had been 3 (range 1–15) years. The drowning incident in childhood was associated with significant deficits in HRQoL in the oldest age group of respondents whose HRQoL total score was significantly lower than that in controls (0.881 vs. 0.971, P < 0.01). In the other two age groups there were no significant differences in the HRQoL total score compared to healthy controls. The median QALY gain was 68.3 (range 40.0–79.8) QALYs. Conclusions: A good health related quality of life will be achieved in the vast majority of patients surviving long-term after a drowning incident as a child. doi:10.1016/j.resuscitation.2010.09.029 AS014 Victorian ambulance cardiac arrest registry Smith K.L. 1,2 , Bray J. 1 , Barnes V. 1 , Lodder M. 1 , Cameron P. 2 , Bernard S. 1,2 , Currell A. 1 1 Strategic
Ethics AS012 Family presence in pediatric resuscitation: Views of physicians and nurses in Greece Iacovidou N. 1 , Vavarouta A. 2 , Aroni F. 2 , Pantazopoulos I. 2 , Xanthos T. 2 1 University of Athens, Medical School, Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens, Greece 2 University of Athens, Medical School, Department of Anatomy, Athens, Greece
Purpose: Family presence during resuscitation and invasive procedures has been a frequent topic of debate among healthcare personnel worldwide. This study determines the knowledge, experiences and views of Greek physicians and nurses on family presence during resuscitation and invasive procedures (FPDRAIP), and examines possible correlations and factors promoting or limiting the implementation of the issue. Materials and methods: The data for this descriptive questionnaire study were collected between March and June 2009. The study population consisted of 44 physicians and 77 nurses working in neonatal-pediatric departments and intensive care units in Patras, Greece, who answered an anonymous questionnaire. Results: The majority of the participants (73.6%) were not familiar with FPDRAIP, were neither educated (72.7%) nor did they agree with the issue (71.9%). No written policy on FPDRAIP existed in the hospitals surveyed. Participants who were familiar with guidelines on the issue, or those who had relevant personal experience (76.9%), were positive for practise of FPDRAIP. The degree of invasiveness of the medical intervention was the major determinant for healthcare personnel to consent for FPDRAIP. Finally, 43.2% of physicians believed that the decision of allowing FPDRAIP should be made only by them, whereas, 40.3% of nurses thought it should be a joint one. Conclusions: This study reveals that healthcare personnel in Greece are not familiar with the issue of FPDRAIP. In view of the increasing evidence on the advantages of this practice, we recommend implementation of relevant educational programs and institutional guidelines and policies. doi:10.1016/j.resuscitation.2010.09.028
2
Planning, Ambulance Victoria, Melbourne, Australia Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
Purpose: To describe trends in cardiac arrests attended by ambulance in Victoria, Australia for the past decade. Materials and methods: VACAR contains information dating back to 1999, for all patients in Victoria (population 5.4 million), who suffer cardiac arrest and receive ambulance care. Ambulance data is captured from patient care records (now electronic) and operational data bases using Utstein criteria.1 Discharge data is obtained from hospital records and the state Death Registry. For discrete projects, aetiology of death is confirmed via the Coroners Database. The registry has also commenced a 12-month quality-of-life follow-up using a telephone interview. Results: From 2000 to 2009 there were 46,438 cardiac arrest patients attended by ambulance (range 3784–5298 per year), of which 72% were due to presumed cardiac aetiology. Twenty-nine percent of arrests were witnessed (7% by paramedics) and 44% had resuscitation attempted by emergency medical services (EMS). Over the decade for adult metropolitan arrests, where EMS commenced resuscitation (n = 13,064), there has been a significant. For metropolitan patients of presumed cardiac aetiology (n = 10,764), the incidence of patients presenting to EMS in ventricular fibrillation/ventricular tachycardia (VF/VT) decreased (41% in 2000 to 34% in 2009). Standard Ustein elements (age, male gender, arrest location, bystander CPR, presenting rhythm and EMS response time) predict survival in Victorian metropolitan patients.2 Conclusion: VACAR is one of the largest cardiac arrest registries in the world. Data is collected from a single state-wide ambulance service (two services prior to 2008), which reduces heterogeneity. Significant improvements in survival have been observed in the metropolitan area of Victoria. References 1. Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, Inter-American Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004;63:233–49. 2. Fridman M, Barnes V, Whyman A, et al. A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register. Resuscitation 2007;75:311–22. doi:10.1016/j.resuscitation.2010.09.030
PEA
tROSC
Without adrenaline (71 patients) Asystole 17 0 VF/VT 1 5 PEA 39 34 tROSC 0 4
Dead
Asystole
3 0 8 0
21 4 0 0
1 0 3 0
sROSC 1 1 12 0
With adrenaline (103 patients) Asystole 18 0 VF/VT 6 17 PEA 46 64 tROSC 0 4
6 0 32 9
57 19 0 39
1 4 47 0
3 1 29 0
tROSC, temporary ROSC; VF/VT, ventricular fibrillation/tachycardia, e.g. eight transitions from PEA to VF/VT occurred in the group without adrenaline compared to 32 in the adrenaline group. Conclusions: Adrenaline has notable effect on resuscitation from PEA, by “speeding up” the dynamics and extending the time window for sROSC to develop. Effects on long-term survival merit further investigation.
S3
ferent in-hospital cooling procedures (single blind randomization) in a multicenter trial (NCT00392639): endovascular using the femoral “CoolGard” device (AlsiusTM ) (ENDO) or external using fans and conventional ice packs (EXT). Results: No statistical difference was observed between the 203 ENDO patients and the 197 EXT patients regarding age, gender, previous co-morbidities, witnessed CA (92%), bystander cardiopulmonary resuscitation (54%), first rhythm for bystander or firemen (shockable rhythm 68%), first medical documented pre-hospital rhythm (ventricular tachycardia 10%, ventricular fibrillation 38%, asystole 38%, pulseless electrical activity 6%), pre- and initial in-hospital temperature, total epinephrine bolus doses. Time to target temperature (33 ◦ C) was significantly shorter in the ENDO group (p < 0.0001). Survival at discharge was similar between the ENDO and EXT groups (42.1 vs 38.1%). Survival without major neurological damages at day 28 (CPC1-2: primary endpoint) was not significantly different [p = 0.11, odds ratio = 1.18 (0.97–1.43)], however with a trend for a better outcome at day 90 (secondary endpoint) in the ENDO group (CPC1-2: 34.8%, 65 patients vs 26.0%, 47 patients, p = 0.067). Conclusion: The use of endovascular cooling for CA patients is not harmful and may have mid-term neuroprotective effects. doi:10.1016/j.resuscitation.2010.09.024
Reference 1. Olasveengen TM, et al. JAMA 2009;302:2222–9. doi:10.1016/j.resuscitation.2010.09.022
Arrhythmias AS009
AS007
Relationship between recurrences of ventricular fibrillation induced by chest compression with outcome in patients with out-of-hospital cardiac arrest
A randomised placebo controlled trial of adrenaline in cardiac arrest—The PACA trial
Aschieri D., Pelizzoni V., Cavanna A., Arvedi M., Nani S., Villani G.Q., Capucci A.
Jacobs I. 1 , Finn J. 2 , Jelinek G. 3 , Oxer H. 4 , Thompson P. 5
Cardiology, Guglielmo Da Saliceto Hospital Piacenza, Italy
1 Discipline
Successful defibrillation may be followed by recurrent ventricular fibrillation (rVF) in out-of-hospital cardiac arrest. It is still unclear whether rVF may influence survival. Purpose: The aim was to determine the relationship between rVF and survival. This is a retrospective study of out-of-hospital cardiac arrest recorded in the city of Piacenza, Italy, where a lay responders project of early defibrillation called “Progetto Vita” was organized. Material and methods: rVF were identified by analyzing the available ECGs from the automated external defibrillators used during cardiac arrest resuscitation attempts. In our study the ECG analysis was supported by the audio recording of rescuers voice during the intervention. The voice of rescuers was used for guiding us to identify the beginning of chest compression (CC) even when the signals were difficult to be interpreted. We calculated the survival rate at hospital discharge without neurologic damage and the mean time to first shock in pts with and without rVF. Results: 160 consecutive patients (pts) had a good quality ECG recordings and were considered for the analysis. Among the 160 pts, 96/160 pts had at least a rVF after the first successful shock (60%): 56/96 rVF (58%) were CC-related and 40/96 (42%) were spontaneous. 64/160 pts (40%) had no rVF after the first successful shock. Pts with no rVF had an higher survival rate compared to pts with rVF post-shock (27/64 = 42% vs 22/96 = 23%).
of Emergency Medicine; University of Western Australia School of Nursing and Midwifery; University of South Australia 3 Dept of Medicine; University of Melbourne 4 St John Ambulance; Western Australia 5 Western Australian Institute for Medical Research, University of Western Australia 2
Background: Adrenaline (epinephrine) remains the primary pharmacological agent in cardiac arrest. Despite a total absence of any experimental trials to establish efficacy, adrenaline is considered standard of care in resuscitation. Methods: A double-blind randomised placebo controlled trial of adrenaline in out-ofhospital cardiac arrest in Perth, Western Australia between August 2006 and November 2009. Patients randomly assigned to receive 1 ml aliquots of adrenaline 1:1000 or sodium chloride (0.9%). Primary outcome was survival to hospital discharge and secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome (Cerebral Performance Category Score). Odds ratios (OR) and 95% confidence intervals were derived and analysis was on an intention to treat basis. Results: 4107 cardiac arrests of which resuscitation was commenced in 1586 (38.6%) patients. Of these 602 (37.9%) were enrolled into the study with a further 67 (11.1%) being excluded after randomisation. Of the remaining 535 patients 262 (48.9%) and 273 (51.0%) received placebo or adrenaline respectively. The percentage male (70.6% versus 74.8%); mean age (64.8 versus 65.4 years) and percentage of patients who received bystander CPR (55.7% versus 53.1%) were similar for the adrenaline and placebo groups respectively. ROSC was achieved in 83 (30.4%) patients receiving adrenaline and 29 (11.1%) receiving placebo OR = 3.51 [95% CI: 2.21–5.58]. Survival to hospital discharge occurred in 11 (4.1%) and 5 (1.9%) of the adrenaline and placebo patients respectively OR = 2.16 [95% CI: 0.74–6.30] Conclusion: Adrenaline in cardiac arrest was associated with a significant increase in the proportion of patients achieving ROSC however not survival to hospital discharge. As these results are unable to rule out a clinically meaningful benefit of adrenaline in terms of survival to hospital discharge, further investigation into the post resuscitation period for those achieving ROSC is required in order to identify management strategies to improve survival. doi:10.1016/j.resuscitation.2010.09.023
doi:10.1016/j.resuscitation.2010.09.025
Paediatric Life Support AS010 Relationship between hyperoxia after cardiopulmonary resuscitation and survival in cardiac arrest in-hospital paediatric patients del Castillo J. 1,2 , López-Herce J. 1,2 , European and Latinoamerican Study Group of Cardiac Arrest in Children 1
Post Resuscitation Care AS008 Interest of endovascular cooling after cardiac arrest Deye N., The ICEREA Study Group Medical ICU, Lariboisiere Hospital, APHP, Paris, France Purpose: Therapeutic hypothermia is recommended for resuscitated cardiac arrest (CA) patients. Whether external or internal cooling is superior or not remains unknown. The aim of this study was to evaluate the interest of endovascular versus external cooling after CA. Methods: Inclusion criteria: age 18–79 years; out-of-hospital CA related to a presumed cardiac aetiology; delay between CA and return of spontaneous circulation (ROSC) <60 min; delay between ROSC and starting cooling <240 min; patient not obeying verbal command after ROSC and prior to start cooling. Non-inclusion criteria: do not reanimate order or terminal disease before inclusion; known pregnancy; clinical hemorrhagic syndrome; known coagulopathy; hypothermia at admission <30 ◦ C; extra-cardiac aetiology of the CA; in-hospital CA; refractory shock. Patients were randomized between two dif-
2
Pediatric Intensive Care Unit, Gregorio Mara˜ non Hospital, Madrid, Spain Red Iberoamericana de Estudio de la Parada Cardiaca en la Infancia
Purpose: Previous investigations have associated arterial hyperoxia in patients following cardiopulmonary resuscitation (CPR) with an increased mortality. To test the hypothesis that postresuscitation hyperoxia is associated with increased mortality in paediatric in-hospital cardiac arrests (CA). Patients and method: a prospective, international, observational, multicentric study was performed in 124 hospitals from 16 European and latinoamerican countries. CA in children between 1 month and 18 years were analysed using the Utstein template. Hyperoxia was defined as PaO2 of 300 mmHg or greater or a ratio of PaO2 to fraction inspired oxygen (PaO2 /FiO2 ) >300; hypoxia, PaO2 of less than 60 mmHg or a ratio of PaO2 to fraction inspired oxygen Results: 543 CA episodes were studied. 214 had arterial blood values registered immediately after return of spontaneous circulation (ROSC) and 170 patients 24 h after. After ROSC, the hyperoxia group (14/36: 39.9%) had lower mortality than the hypoxia group (62/133: 46.6%), but higher than the normoxia group (8/25: 32%) according PaO2 /FiO2 criteria, but it did not reach statistical signification (p = 0.34). According to PaO2 criteria, mortality was lower in the hyperoxia group (5/14: 35.7%) than the normoxia group (57/140: 40.7%) and the hypoxia group (25/51: 49%) (p = 0.51). 24 h after ROSC, mortality rate was higher in the hyperoxia group (1/2: 50%) than in the hypoxia group (63/151: 41.7%), but lower than the normoxia group (2/3: 66.7%) according to PaO2 /FiO2 criteria. The differences were not statistically significant (p = 0.67). According PaO2 criteria mor-
S4
Abstracts / Resuscitation 81S (2010) S1–S114
tality was higher amongst the hyperoxia group (1/3: 33.3%) than in the normoxia (45/138: 32.6%) and hypoxia (10/25: 40%) groups (p = 0.78). Conclusions: In children following CPR after in-hospital CA, arterial hyperoxia is rare and is not associated with an increase in mortality when compared to normoxia or hypoxia.
Epidemiology & Outcome AS013 Health-related quality of life after a drowning incident as a child
doi:10.1016/j.resuscitation.2010.09.026
Suominen P. 1 , Roine R. 2
Newborn Life Support
1 Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki, Finland 2 Administration, Helsinki and Uusimaa Hospital District, Helsinki, Finland
AS011 Analysis of inflation breaths during face mask resuscitation in preterm infants Murthy V. 1 , Fox G.F. 2 , Campbell M.E. 2 , Milner A. 1 , Greenough A. 1 1 School of Medicine, Division of Asthma, Allergy and Lung Biology, King’s College London, UK 2
Evelina Children’s Hospital Neonatal Unit, St Thomas’ Hospital, London, UK
Purpose of the study: Positive pressure ventilation with a prolonged inspiratory time is recommended to establish a functional residual capacity and deliver appropriate tidal volume at preterm resuscitation. The aim of the study was to analyse the peak inspiratory pressure (PIP), tidal volume (TV), inspiratory time (Ti) and face mask leak during the first five inflation breaths at preterm resuscitation. Patient and methods: The study used respiratory function monitor (NM3, Respironics) and a computer laptop with recording and analysis software (Spectra, Groove medical, UK) to analyse the flow, pressure and volume traces. The monitoring equipment recorded data at resuscitation of preterm infants born before 34 weeks of gestation. The study was conducted between March and July 2010 at King’s College Hospital, London. Clinicians involved in preterm resuscitation were trained and certified in newborn life support (Resuscitation council, UK). Parental consent was obtained for analysis of the data and the study was approved by Outer North London ethics committee. Results: A total of 100 inflation breaths from 21 preterm resuscitations were analysed. Median peak inspiratory pressure (PIP) was 25.1; range 19.7–38 cm H2 O, expired tidal volume (TVe) was 3.3 ml/kg; range 0.2–19.8 ml/kg, face mask leak was 43.1%; range 1–96%, inspiratory time was 1.1 s; range 0.2–3.2 s. Face mask leak was calculated from the inspired and expired tidal volume. Significant correlation was noted between PIP and TVe (r = 0.36). Conclusion: Inspiratory time achieved during the first five inflation breaths at preterm resuscitation is significantly lower than that recommended (2–3 s) by the resuscitation council. Using longer inspiratory times and minimising face mask leak may help to achieve optimal tidal volumes during preterm resuscitation. doi:10.1016/j.resuscitation.2010.09.027
Purpose of the study: To describe the health-related quality of life (HRQoL) and qualityadjusted life years (QALYs) in children and adults who had received cardiopulmonary resuscitation (CPR) after a drowning incident as a child. Materials and methods: Altogether 64 drowned children were admitted to the pediatric intensive care unit (PICU) of the Hospital for Children and Adolescents after successful CPR between 1985 and 2007. Eleven patients died in the PICU and 9 other patients within 6 months from the incident. In 2009 all the 44 long-term survivors, except 2, lived at home. Of the 42 patients who’s address could be located, 29 (69%) responded to a questionnaire. Depending on the age of the patients, HRQoL was assessed with the generic 15D questionnaire, or the versions developed for adolescents (16D) or children (17D), and compared to that of the general population. Incremental QALYs were calculated assuming that without treatment the patients would have died and that the reported HRQoL would remain constant from one year from the incident to the remaining statistical life expectancy of each patient. Results: The median age of the respondents was 17.0 (range 2–28) years and 62% of them were male. At the time of the drowning incident their median age had been 3 (range 1–15) years. The drowning incident in childhood was associated with significant deficits in HRQoL in the oldest age group of respondents whose HRQoL total score was significantly lower than that in controls (0.881 vs. 0.971, P < 0.01). In the other two age groups there were no significant differences in the HRQoL total score compared to healthy controls. The median QALY gain was 68.3 (range 40.0–79.8) QALYs. Conclusions: A good health related quality of life will be achieved in the vast majority of patients surviving long-term after a drowning incident as a child. doi:10.1016/j.resuscitation.2010.09.029 AS014 Victorian ambulance cardiac arrest registry Smith K.L. 1,2 , Bray J. 1 , Barnes V. 1 , Lodder M. 1 , Cameron P. 2 , Bernard S. 1,2 , Currell A. 1 1 Strategic
Ethics AS012 Family presence in pediatric resuscitation: Views of physicians and nurses in Greece Iacovidou N. 1 , Vavarouta A. 2 , Aroni F. 2 , Pantazopoulos I. 2 , Xanthos T. 2 1 University of Athens, Medical School, Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens, Greece 2 University of Athens, Medical School, Department of Anatomy, Athens, Greece
Purpose: Family presence during resuscitation and invasive procedures has been a frequent topic of debate among healthcare personnel worldwide. This study determines the knowledge, experiences and views of Greek physicians and nurses on family presence during resuscitation and invasive procedures (FPDRAIP), and examines possible correlations and factors promoting or limiting the implementation of the issue. Materials and methods: The data for this descriptive questionnaire study were collected between March and June 2009. The study population consisted of 44 physicians and 77 nurses working in neonatal-pediatric departments and intensive care units in Patras, Greece, who answered an anonymous questionnaire. Results: The majority of the participants (73.6%) were not familiar with FPDRAIP, were neither educated (72.7%) nor did they agree with the issue (71.9%). No written policy on FPDRAIP existed in the hospitals surveyed. Participants who were familiar with guidelines on the issue, or those who had relevant personal experience (76.9%), were positive for practise of FPDRAIP. The degree of invasiveness of the medical intervention was the major determinant for healthcare personnel to consent for FPDRAIP. Finally, 43.2% of physicians believed that the decision of allowing FPDRAIP should be made only by them, whereas, 40.3% of nurses thought it should be a joint one. Conclusions: This study reveals that healthcare personnel in Greece are not familiar with the issue of FPDRAIP. In view of the increasing evidence on the advantages of this practice, we recommend implementation of relevant educational programs and institutional guidelines and policies. doi:10.1016/j.resuscitation.2010.09.028
2
Planning, Ambulance Victoria, Melbourne, Australia Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
Purpose: To describe trends in cardiac arrests attended by ambulance in Victoria, Australia for the past decade. Materials and methods: VACAR contains information dating back to 1999, for all patients in Victoria (population 5.4 million), who suffer cardiac arrest and receive ambulance care. Ambulance data is captured from patient care records (now electronic) and operational data bases using Utstein criteria.1 Discharge data is obtained from hospital records and the state Death Registry. For discrete projects, aetiology of death is confirmed via the Coroners Database. The registry has also commenced a 12-month quality-of-life follow-up using a telephone interview. Results: From 2000 to 2009 there were 46,438 cardiac arrest patients attended by ambulance (range 3784–5298 per year), of which 72% were due to presumed cardiac aetiology. Twenty-nine percent of arrests were witnessed (7% by paramedics) and 44% had resuscitation attempted by emergency medical services (EMS). Over the decade for adult metropolitan arrests, where EMS commenced resuscitation (n = 13,064), there has been a significant. For metropolitan patients of presumed cardiac aetiology (n = 10,764), the incidence of patients presenting to EMS in ventricular fibrillation/ventricular tachycardia (VF/VT) decreased (41% in 2000 to 34% in 2009). Standard Ustein elements (age, male gender, arrest location, bystander CPR, presenting rhythm and EMS response time) predict survival in Victorian metropolitan patients.2 Conclusion: VACAR is one of the largest cardiac arrest registries in the world. Data is collected from a single state-wide ambulance service (two services prior to 2008), which reduces heterogeneity. Significant improvements in survival have been observed in the metropolitan area of Victoria. References 1. Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, Inter-American Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 2004;63:233–49. 2. Fridman M, Barnes V, Whyman A, et al. A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register. Resuscitation 2007;75:311–22. doi:10.1016/j.resuscitation.2010.09.030