Pediatric Basic Life Support(BLS) Prognosis
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
- ↑ 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.
- ↑ 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.
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.
| 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) |
| 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
- ↑ 1.0 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.
- ↑ 2.0 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.
- ↑ 3.0 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.
- ↑ 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.
- ↑ 5.0 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.