Outcome Predictors of Pediatric Extracorporeal Cardiopulmonary Resuscitation

Extracorporeal cardiopulmonary resuscitation (ECPR) allows clinicians to potentially rescue pediatric patients unresponsive to traditional cardiopulmonary resuscitation (CPR). Clinical and laboratory variables predictive of survival to hospital discharge are beginning to emerge. In this retrospective, historical cohort case series, clinical, and laboratory data from 31 pediatric patients (<21 years of age) receiving ECPR from March 2000 to April 2006 at our university-affiliated, tertiary-care children’s hospital were statistically analyzed in an attempt to identify variables predictive of survival to hospital discharge. Seven patients survived to hospital discharge (23%), and 24 patients died. Survival was independent of gender, age, and CPR duration. ECPR survival was, however, associated with a lower pre-ECPR phosphorus concentration (P = 0.002) and a lower pre-ECPR creatinine concentration (P = 0.05). A classification tree analysis, using, in part, a pre-ECPR phosphorus concentration threshold and a CPR ABG base excess concentration threshold, yielded a 96% nominal accuracy of predicting survival to hospital discharge or death. A large, multicenter, prospective cohort study aimed at validating these predictive variables is needed to guide appropriate ECPR patient selection. This study reveals the potential survival benefit of ECPR for pediatric patients, regardless of CPR duration prior to ECPR cannulation.     

儿童心肺复苏术的研究状况和对比

心肺复苏指南自1974年制定以来,多次修订改进。2005年心肺复苏和心血管病急诊科学治疗建议国际会议的召开,对心肺复苏指南再次进行了修订,并利用循证程序就心肺复苏的治疗推荐方案达成了一致性意见。本文主要对心肺复苏的程序进行简略介绍,并对历年的心肺复苏指南作以简单比较。     

Impacts of a Pediatric Extracorporeal Cardiopulmonary Resuscitation (ECPR) Simulation Training Program

ObjectiveTo examine the impacts of a large-scale simulation-based extracorporeal cardiopulmonary resuscitation (ECPR) training program in an academic children's hospital.MethodsThe study followed a quasi-experimental, mixed-method, time series design. Two-hour high-fidelity ECPR simulations were held monthly in the pediatric, cardiac, and neonatal intensive care units. Intensive care unit–specific cases were used in each unit. The learning objectives for all cases were the same. Each simulation included an average of 11 health care professionals, including nurses, physicians, respiratory therapist, and perfusionists. Impacts of training were examined using Kirkpatrick's 4-level model: reactions, learning, behaviors, and results. Participant surveys, semistructured interviews, facilitator observations, applied cognitive task analysis, and hospital code data were used to examine the impacts of training.ResultsFrom February 2014 to October 2016, a total of 332 health care professionals participated in 29 ECPR simulations. Participants enjoyed the simulations and reported learning gains. Applied cognitive task analysis revealed 2 specific behaviors, coordination of compressions with surgical cannulation and performing sterile compressions, that were targeted for further training. The rate of adherence to the ECPR activation protocol improved from 83% (48/58) before simulations started to 95% (92/97) after simulations (P = .02). ECPR activation time decreased from 7 minutes (interquartile range, 4–9 minutes) before simulations started to 2 minutes (interquartile range, 1–4 minutes) after simulations (P < .01).ConclusionsLarge-scale simulation-based ECPR training was associated with positive reactions, learning gains, behavioral change, improved adherence to the ECPR activation protocols, and faster activation times. Other children's hospital that perform ECPR should consider simulation-based training.     

2005年国际小儿心肺复苏指南解读——高级生命支持

2005年国际小儿心肺复苏指南(以下简称“指南2005”)包括两大部分,第一部分为基础生命支持(PBLS),可适用于各类急救人员,包括非医护人员;第二部分为高级生命支持(PALS),仅适用于医护人员,特别是小儿危重病医护人员[1]。与2000年国际小儿心肺复苏指南[2,3](以下简称“指南2000”     

Improvement of Skills in Cardiopulmonary Resuscitation of Pediatric Residents by Recorded Video Feedbacks

Objective

To evaluate the pediatric residents’ cardiopulmonary resuscitation (CPR) skills, and their improvements after recorded video feedbacks.

Methods

Pediatric residents from a university hospital were enrolled. The authors surveyed the level of pediatric resuscitation skill confidence by a questionnaire. Eight psychomotor skills were evaluated individually, including airway, bag-mask ventilation, pulse check, prompt starting and technique of chest compression, high quality CPR, tracheal intubation, intraosseous, and defibrillation. The mock code skills were also evaluated as a team using a high-fidelity mannequin simulator. All the participants attended a concise Pediatric Advanced Life Support (PALS) lecture, and received video-recorded feedback for one hour. They were re-evaluated 6 wk later in the same manner.

Results

Thirty-eight residents were enrolled. All the participants had a moderate to high level of confidence in their CPR skills. Over 50 % of participants had passed psychomotor skills, except the bag-mask ventilation and intraosseous skills. There was poor correlation between their confidence and passing the psychomotor skills test. After course feedback, the percentage of high quality CPR skill in the second course test was significantly improved (46 % to 92 %, p = 0.008).

Conclusions

The pediatric resuscitation course should still remain in the pediatric resident curriculum and should be re-evaluated frequently. Video-recorded feedback on the pitfalls during individual CPR skills and mock code case scenarios could improve short-term psychomotor CPR skills and lead to higher quality CPR performance.

     

2005年国际小儿心肺复苏指南解读--基础生命支持

五年一度的国际心肺复苏指南(CPR)修订工作已于2005年1月在美国达拉斯市国际心肺复苏和心血管急救大会上完成。在对大量文献进行系统回顾与评价的基础上,大会对2000年国际小儿心肺复苏与心血管急救指南[1,2](以下简称“指南2000”)作出修订,同年11月美国《循环》杂志发表了指南     

Report of the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures

Representatives from 18 national organizations were convened for a conference to develop recommendations regarding family presence (FP) during pediatric procedures and cardiopulmonary resuscitation. Before the conference, invitees were given a questionnaire and provided with current literature regarding FP. A modified Delphi process was used to develop consensus, including use of multiple questionnaires and breakouts for discussion of specific issues. Participants were encouraged to develop consensus recommendations based on the literature and discussions. Changes in attitude were tracked with repeat questionnaires. Results of the conference were circulated to participants for review and revision. Consensus recommendations include (1) consider FP as an option for families during pediatric procedures and cardiopulmonary resuscitation, (2) offer FP as an option after assessing factors that could adversely affect the interaction, (3) if family is not offered the option for FP, document the reasons why, (4) always consider the safety of the health care team, (5) develop in-hospital transport and transfer policies and procedures for FP, such as family member definition, preparation of the family, handling disagreements, and providing support for the staff, (6) obtain legal review of policies, (7) include education in FP in all core curricula and orientation for health care providers, (8) promote research into best methods for education; effects of FP on patients, family, and staff; best practices for FP; and legal issues regarding FP, among others. These recommendations were approved in concept by the American Academy of Pediatrics and the Ambulatory Pediatrics Association.     

2010年美国心脏病协会儿童心肺复苏指南更新要点解读

2010年10月美国心脏病协会发表了新的儿童基础和高级生命支持指南,与2005版指南对照,新指南更新的内容主要涉及儿童复苏的2个方面:促进自主循环恢复和复苏后稳定,包括简化评估程序,心肺复苏操作顺序由A-B-C变为C-A-B,高质量的胸外按压,自动体外除颤仪的使用和除颤,自主循环恢复后调节吸入氧体积分数,以达到适当的氧饱和度,复苏过程中钙剂和依托咪酯的使用,复苏后治疗性低体温的应用等.现简要介绍主要更新内容及其依据.     

2010年儿童心肺复苏及生命支持指南解读

美国心脏协会已完成2010年国际心肺复苏指南修订工作.在对大量文献进行系统回顾与评价的基础上,美国心脏协会对2005年国际小儿心肺复苏与心血管急救指南[1]作了修订,已在2010年10月美国<循环>杂志全文发表了新的指南[2].本文将主要解读2010年国际小儿心肺复苏指南(以下简称为2010年指南)的重要修改内容及其背景.     

心肺复苏后内环境的变化及治疗

心肺复苏（CPR）后的内环境变化是由于呼吸、心跳停止造成全身器官缺氧缺血和复苏后循环重新建立，各缺血器官血流恢复，进而发生再灌注损伤所致的一系列病理生理过程。及时治疗由此继发的严重代谢紊乱和多器官功能障碍，尤其是及时进行脑复苏，是获得CPR真正成功的关键。     

Summary of Japanese Neonatal Cardiopulmonary Resuscitation Guidelines 2015

The Japan Resuscitation Council joined the International Liaison Committee on Resuscitation (ILCOR) as a member of the Resuscitation Council of Asia in 2006. In 2007, the Japan Society of Perinatal and Neonatal Medicine (JSPNM), which is a member of an affiliated body, launched the Neonatal Cardiopulmonary Resuscitation (NCPR) program as an authorized project to ensure that all staff involved in perinatal and neonatal medicine can learn and practice neonatal cardiopulmonary resuscitation based on the Consensus on Science with Treatment Recommendations developed by ILCOR. The content of courses in the NCPR program is based on the NCPR guidelines. These guidelines are revised by the Japan Resuscitation Council according to the Consensus on Science with Treatment Recommendations, which is updated by ILCOR every 5 years. The latest updated edition in Japanese was published in 2016 and we translated these Japanese guidelines to English in 2018. Here, we introduce a summary of the NCPR guidelines 2015 in Japan. The NCPR 2015 algorithm has two flows, “lifesaving flow” and “stabilization of breathing flow” at the first branching point after the initial step of resuscitation.