Special Report-Pediatric Basic and Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Circulation (Impact Factor: 14.95). 10/2010; 122(16 Suppl 2):S466-515. DOI: 10.1161/CIRCULATIONAHA.110.971093
Source: PubMed
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    ABSTRACT: Evaluate, by radiographic analysis, tibial growth after an intraosseous infusion (IOI) in a pediatric population. We performed a prospective simple blind study, between January 1, 1994, and July 1, 2001, which included pediatric patients who needed an intraosseous trocar in emergency situations. During the follow-up, roentgenographs were performed. On each radiologic view, different measurements were carried out: anterior and lateral tibial length, anterior and lateral width at 2 diaphyseal levels. We compared the anterior length values to those published in the Anderson et al tables. When only one tibia was punctured, the mean measurements were compared with the control leg measurements using a paired t test. The initial population included 78 patients. Of these 78 subjects, 42 died, 10 families could not be contacted, and one refused to participate. Two children were excluded because they had other conditions that could influence tibial growth. The study included 23 children. The puncture site was the proximal tibia. The mean age was 18.6 months at the time of IOI, the mean time of infusion was 5 hours, and the mean perfused volume was 225 mL. The mean radiologic follow-up time was 29.2 months. When compared with the Anderson et al tables, all the anterior length values were within the 95% confidence interval. For the other measurements, the statistical analysis showed no significant difference between punctured and control legs. There is no long-term effect on tibial growth after an IOI when the IO trocar is properly placed.
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    ABSTRACT: There are a number of reports of delayed return of spontaneous circulation after pulseless arrest (the Lazarus phenomenon) in adults. There are no published reports of this phenomenon in children. We report 2 pediatric cases of the Lazarus phenomenon, likely caused by unintentional hyperventilation during resuscitation.
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    ABSTRACT: International guidelines recommend a compression to ventilation (C:V) ratio of 3:1 in neonates, and 15:2 for other paediatric age groups. The authors aimed to compare these two C:V ratios in a neonatal swine model of cardiac arrest following asphyxia. Experimental animal study. Facility for animal research. 22 newborn pigs (age 12-36 h, weight 2.0-2.7 kg). Progressive asphyxia until asystole. Animals were randomised to receive C:V 3:1 (n=11) or 15:2 (n=11). Return of spontaneous circulation (ROSC) was defined as a heart rate ≥ 100 bpm. Also of interest were haemodynamic parameters, cerebral and systemic oxygen saturation and the proinflammatory cytokine interleukin-1β (IL-1β). Two animals in each group did not achieve ROSC. Mean (SD) increase in diastolic blood pressure (DBP; mm Hg) during compression cycles was significantly higher at a C:V ratio of 15:2 than 3:1 (7.1 (2.8) vs 4.8 (2.6)). Median time (IQR) to ROSC for the 3:1 group was 150 (140-180) s, and 195 (145-358) s for the 15:2 group. There were no significant differences in the temporal changes in haemodynamic parameters or oxygen saturation indices between the groups. IL-1β levels in cerebrospinal and bronchoalveolar lavage fluid was comparable between the groups. In neonatal pigs with asphyxia-induced cardiac arrest, the response to a C:V ratio of 15:2 is not better than the response to a C:V ratio of 3:1 despite better generation of DBP during resuscitation.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 03/2011; 96(6):F417-21. DOI:10.1136/adc.2010.200386 · 3.86 Impact Factor
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