Pediatric Basic Life Support(BLS) Prognosis

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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.

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.

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