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

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==Prognosis==
==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.<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>
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 <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 -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 <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- 621 Children (RR- 2.7; 95% CI,1.3-5.7)
|-
|Good prognosis associated in children >1 year
|Kelly D. Young<ref name="pmid15231922">{{cite journal| author=Young KD, Gausche-Hill M, McClung CD, Lewis RJ| title=A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. | journal=Pediatrics | year= 2004 | volume= 114 | issue= 1 | pages= 157-64 | pmid=15231922 | doi=10.1542/peds.114.1.157 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15231922  }} </ref>
|Study group- 599 Children (RR- 1.3; 95% CI,0.8-2.1)
|-
|Good prognosis associated in children >1 year
|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- 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
*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 />
{{Reflist|2}}


 
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[[Category: (Pediatrics)]]
The following tables provide the details of the different studies done to determine which factors during pediatric cardiac arrest resuscitation have a superior prognosis.
 
=== Age Greater or Less Than 1 Year ===
* 30-day survival with good neurologic outcome
**A observational study identified children with age >1 year had better 30-day survival with good neurologic outcomes.
***The study - The observational study with 5158 children 1 pediatric observational study of OHCA (5158 subjects)52 in which age greater than 1 year was associated with improved survival when compared with age less than 1 year (relative risk [RR], 2.4; 95% CI, 1.7–3.4).
 
 
 
 
 
For the critical outcome of survival to 180 days with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for imprecision and risk of bias) from 1 pediatric observational prospective cohort study of IHCA and OHCA,102 enrolling 43 children showing that reactive pupils at 24 hours after ROSC is associated with improved outcomes (RR, 5.94; 95% CI, 1.5–22.8).
 
For the important outcome of survival to hospital discharge, we identified very-low-quality evidence for prognostic significance (downgraded for imprecision and risk of bias, but with a moderate dose-response relationship) from 4 pediatric observational studies of IHCA and OHCA,79,82,101,103 enrolling a total of 513 children showing that pupils reactive to light 12 to 24 hours after ROSC is associated with improved outcomes (RR, 2.3; 95% CI, 1.8–2.9).
 
For the important outcome of survival to hospital discharge with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for risk of bias and imprecision, but with a moderate effect size) from 2 pediatric observational studies of IHCA and OHCA,101,103 enrolling a total of 69 children showing that pupils reactive to light before hypothermia or 24 hours after ROSC is associated with improved outcomes (OR, 3.0; 95% CI, 1.4–6.5).
 
For the important outcomes of survival to hospital discharge and hospital discharge with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for risk of bias and imprecision) from 2 pediatric observational studies of IHCA and OHCA,102,104 enrolling a total of 78 children showing that lower neuron-specific enolase (NSE) or S100B serum levels at 24, 48, and 72 hours are associated with an increased likelihood of improved outcomes (P<0.001 to P<0.02).
 
For the important outcome of survival to hospital discharge, we identified very-low-quality evidence for prognostic significance (downgraded for imprecision and risk of bias) from 1 pediatric observational study of IHCA and OHCA,105 enrolling 264 children showing that lower serum lactate levels at 0 to 6 hours (P<0.001) and 7 to 12 hours (P<0.001) after ROSC are associated with improved outcomes.

Revision as of 01:20, 1 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 [1] 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.[2]

References

  1. ↑ Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA; et al. (2017). "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". JAMA Pediatr. 171 (2): 133–141. doi:10.1001/jamapediatrics.2016.3643. PMID 27837587.
  2. ↑ Sahu S, Kishore K, Lata I (2010). "Better outcome after pediatric resuscitation is still a dilemma". J Emerg Trauma Shock. 3 (3): 243–50. doi:10.4103/0974-2700.66524. PMC 2938489. PMID 20930968.

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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.[1] 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 [2] 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 [2] 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 [3] Study group- 621 Children (RR- 2.7; 95% CI,1.3-5.7)
Good prognosis associated in children >1 year Kelly D. Young[4] Study group- 599 Children (RR- 1.3; 95% CI,0.8-2.1)
Good prognosis associated in children >1 year Moler, Frank W. MD[5] 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 [2] 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 [2] 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 [3] Study group- 366 Children (RR- 4.0; 95% CI,1.8-8.9)
Good prognosis with shockable rhythm like VF Moler, Frank W. MD[5] Study group- 138 Children (RR- 2.7; 95% CI,1.3-5.6)

Variables with the good prognostic outcome[1]

  • Age >1 year
  • Shockable rhythm like ventricular fibrillation
  • Less duration of CPR
  • Reactive pupil at 24 hours after ROSC
  • Lower serum lactate levels at 0 to 12 hours after ROSC is associated with improved outcomes.

References

  1. ↑ 1.0 1.1 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.
  2. ↑ 2.0 2.1 2.2 2.3 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.
  3. ↑ 3.0 3.1 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.
  4. ↑ Young KD, Gausche-Hill M, McClung CD, Lewis RJ (2004). "A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest". Pediatrics. 114 (1): 157–64. doi:10.1542/peds.114.1.157. PMID 15231922.
  5. ↑ 5.0 5.1 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.

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