Vinay Nadkarni

Vinay Nadkarni
The Children's Hospital of Philadelphia | CHOP · Department of Anesthesia and Critical Care Medicine

About

565
Publications
89,425
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33,056
Citations
Citations since 2016
216 Research Items
19377 Citations
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201620172018201920202021202205001,0001,5002,0002,5003,0003,500
201620172018201920202021202205001,0001,5002,0002,5003,0003,500

Publications

Publications (565)
Article
Objectives: Capillary refill time (CRT) to assess peripheral perfusion in children with suspected shock may be subject to poor reproducibility. Our objectives were to compare video-based and bedside CRT assessment using a standardized protocol and evaluate interrater and intrarater consistency of video-based CRT (VB-CRT) assessment. We hypothesize...
Article
Objectives: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient...
Article
Full-text available
Simulation based training (SBT) plays a pivotal role in quality improvement and patient safety. Simulation is not only for training health care professionals but also an excellent tool for systems and facility changes which will potentially improve patient safety and ultimately outcomes. SBT is already established both as a training modality, and a...
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Objectives: To evaluate associations between sodium bicarbonate use and outcomes during pediatric in-hospital cardiac arrest (p-IHCA). Design: Prespecified secondary analysis of a prospective, multicenter cluster randomized interventional trial. Setting: Eighteen participating ICUs of the ICU-RESUScitation Project (NCT02837497). Patients: Ch...
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Introduction Pediatric shock, especially septic shock, is a significant healthcare burden in low-income countries. Early recognition and management of shock in children improves patient outcome. Simulation-based education (SBE) for shock recognition and prompt management prepares interdisciplinary pediatric emergency teams in crisis management. COV...
Article
Objectives: Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1 mg, which corresponds to a weight of 100 kg. Actual practice patterns are unknown. Design: Multicenter cross-sectional survey regarding institutional practices for the transition from weight-base...
Article
Background: There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. Aim: Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubat...
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Full-text available
Objective The effect of cardiac arrest (CA) on cerebral transcriptomics and metabolomics is unknown. We previously demonstrated hemodynamic-directed CPR (HD-CPR) improves survival with favorable neurologic outcomes versus standard CPR (Std-CPR). We hypothesized HD-CPR would preserve the cerebral transcriptome and metabolome compared to Std-CPR. De...
Article
Objectives: To compare outcomes associated with timing-early versus late-of any neurologic dysfunction during pediatric sepsis. Design: Secondary analysis of a cross-sectional point prevalence study. Setting: A total of 128 PICUs in 26 countries. Patients: Less than 18 years with severe sepsis on 5 separate days (2013-2014). Interventions:...
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Objective To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes. Methods Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥10 mi...
Article
Importance: Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes. Objective: To eva...
Article
Aim Cerebral oxygenation (rSO2) is not routinely measured during pediatric cardiopulmonary resuscitation (CPR). We aimed to determine whether higher intra-arrest rSO2 was associated with return of spontaneous circulation (ROSC) and survival to hospital discharge. Methods Prospective, single-center observational study of cerebral oximetry using nea...
Article
Introduction: Shockable rhythms (ventricular fibrillation [VF] and ventricular tachycardia [VT]) occur in <25% of pediatric in-hospital cardiac arrest (IHCA) events, yet the prevalence of inappropriate defibrillation attempts for non-VF/VT rhythms is unknown. We aim to describe the prevalence of inappropriate shocks across a large, multi-national p...
Article
Introduction: Survival of adult patients with COVID-19 who had an in-hospital cardiac arrest (IHCA) are poor. Characteristics and outcomes for pediatric IHCA patients with COVID-19 are unknown. Hypothesis: We hypothesized that pediatric COVID-19 patients would have worse survival outcomes when compared to non-COVID patients. Methods: A multicenter,...
Article
Objectives Develop and evaluate a high-dimensional, data-driven model to identify patients at high risk of clinical deterioration from routinely-collected electronic health record (EHR) data. Methods In this single-center, retrospective cohort study, 488 patients with single-ventricle and shunt-dependent congenital heart disease (CHD) <6 months ol...
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Previous pilot experience has shown the ability of visually impaired and blind people (BP) to learn basic life support (BLS), but no studies have compared their abilities with blindfolded people (BFP) after participating in the same instructor-led, real-time feedback training. Twenty-nine BP and 30 BFP participated in this quasi-experimental trial....
Article
Background There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with rescue breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA). Objectives This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable...
Article
Aims: To determine the prevalence of pulmonary hypertension (PH) among children with in-hospital cardiac arrest (IHCA) and its association with survival. Methods: Children (<18 years) admitted to ICUs participating in the Virtual Pediatric Systems multicenter registry between January 2011 and December 2017 who had an IHCA during their hospitaliz...
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Full-text available
Background: Although some pediatric sepsis survivors experience worsening health-related quality of life (HRQL), many return to their pre-illness HRQL. Whether children can improve beyond baseline is not known. We examined a cohort of pediatric sepsis survivors to determine if those with baseline HRQL scores below the population mean could exhibit...
Article
Introduction: The COVID-19 pandemic forced healthcare institutions to rapidly adapt practices for patient care, staff safety, and resource management. We evaluated contributions of the simulation center in a freestanding children's hospital during the early stages of the pandemic. Methods: We reviewed our simulation center's activity for educati...
Article
Rationale: Animal studies of cardiac arrest suggest shorter epinephrine dosing intervals than currently recommended (every 3-5 minutes) may be beneficial in select circumstances. Objectives: To evaluate the association between epinephrine dosing intervals and pediatric cardiac arrest outcomes. Methods: Single-center retrospective cohort study...
Article
The history of cardiopulmonary resuscitation and the Society of Critical Care Medicine have much in common, as many of the founders of the Society of Critical Care Medicine focused on understanding and improving outcomes from cardiac arrest. We review the history, the current, and future state of cardiopulmonary resuscitation.
Article
Background Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and survival in adults but has not been studied in pediatric cardiac arrest. We characterized AMSA during pediatric cardiac arrest from a Pediatric Resuscitation Quality Collaborative and hypothesized that AMSA would be...
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Full-text available
Aim To evaluate the individual use and predictive value of focused echocardiography, end-tidal carbon dioxide (EtCO2), invasive arterial blood pressure (BP) and near-infrared spectroscopy (NIRS) during cardiopulmonary resuscitation (CPR) in children. Methods This scoping review was undertaken as part of the continuous evidence evaluation process o...
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Objective Cerebral mitochondrial dysfunction is a key mediator of neurologic injury following cardiac arrest (CA) and is regulated by the balance of fusion and fission (mitochondrial dynamics). Under stress, fission can decrease mitochondrial mass and signal apoptosis, while fusion promotes oxidative phosphorylation efficiency. This study evaluates...
Article
Introduction Guideline deviations with impact on patient outcomes frequently occur during in-hospital cardiopulmonary resuscitation (CPR). However, barriers and facilitators for preventing these guideline deviations are understudied. We aimed to characterize challenges occurring during IHCA and identify barriers and facilitators perceived by actual...
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Full-text available
Introduction Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-t...
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Background The use of electronic clinical decision support (CDS) systems for pediatric critical care trials is rare. We sought to describe in detail the use of a CDS tool (Children’s Hospital Euglycemia for Kids Spreadsheet- CHECKS), for the management of hyperglycemia during the 32 multicenter Heart And Lung Failure-Pediatric INsulin Titration (HA...
Chapter
The major role of the circulatory system is to supply all tissue beds with appropriate oxygen and nutrients and effectively remove the end products of metabolism. During critical illness or injury, the circulatory system must adjust flow to organs and tissues to assure delivery of adequate oxygen and metabolic substrate to vital organs (i.e., the h...
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Full-text available
Introduction/Hypothesis The outcome of cardiopulmonary resuscitation (CPR) depends on timely recognition of the underlying cause of cardiac arrest. Ventricular fibrillation (VF) waveform analysis to differentiate primary VF from secondary asphyxia-associated VF may allow tailoring of therapies to improve cardiac arrest outcomes. Therefore, the prim...
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Aim Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomoto...
Article
Aim Inhaled nitric oxide (iNO) during cardiopulmonary resuscitation (CPR) improved systemic hemodynamics and outcomes in a preclinical model of adult in-hospital cardiac arrest (IHCA) and may also have a neuroprotective role following cardiac arrest. The primary objectives of this study were to determine if iNO during CPR would improve cerebral hem...
Article
Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention-the starting point for delivery of "All the right care, but only the right care," an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are ba...
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Full-text available
Neurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulatio...
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Full-text available
Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency i...
Article
Background Quantifying nurses’ perceptions of workload burden when managing critically ill patients is essential for designing interventions to ease nurses’ workday. Objectives To explore pediatric intensive care unit (PICU) nurses’ perceptions of their workload when caring for critically ill patients and managing protocolized therapies. Methods...
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Full-text available
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: system...
Article
Full-text available
Aim Compare vasopressin to a second dose of epinephrine as rescue therapy after ineffective initial doses of epinephrine in diverse models of pediatric in-hospital cardiac arrest. Methods 67 one- to three-month old female swine (10−30 kg) in six experimental cohorts from one laboratory received hemodynamic-directed CPR, a resuscitation method wher...
Article
Background Orotracheal intubation of infants using direct laryngoscopy can be challenging. We aimed to investigate whether video laryngoscopy with a standard blade done by anaesthesia clinicians improves the first-attempt success rate of orotracheal intubation and reduces the risk of complications when compared with direct laryngoscopy. We hypothes...
Article
Objectives: To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City. Study design: Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2,2020, to 9 New York City pediatric intensive care units (PICUs) with severe acute respiratory...
Article
Introduction: AHA recommends titrating chest compressions (CC) to achieve end-tidal carbon dioxide (ETCO2)>20mmHg, based on laboratory, adult, and very limited pediatric IHCA data. Hypothesis: ETCO2>20mmHg averaged during the first 10 min of recorded CPR is associated with 1) compliance with AHA CC depth quality targets, and 2) survival to hospital...
Article
Introduction: Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and hospital survival in adults, but has not been studied during pediatric cardiac arrest (pCA). Hypothesis: We characterized AMSA during pCA from a pediatric resuscitation quality (pediRES-Q) collaborative and hypot...
Article
Introduction: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest (IHCA) survival outcomes is unknown. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. Methods: Cohort study of all index pediatric IHCAs (<18 years of age) ≥1 min in...
Article
Introduction: Pediatric Advanced Life Support (PALS) guidelines include weight-based epinephrine dosing recommendations (0.01 mg/kg with a maximum dose of 1mg), but do not specify the age or weight at which adult (flat) dosing should be provided. Hypothesis: We hypothesized that there would be considerable practice variation in the transition from...
Article
Introduction: Inhaled nitric oxide (iNO) may result in higher systemic BP during CPR and may have a neuroprotective role post-arrest, but its effects on cerebral perfusion pressure (CePP), cerebral blood flow (CBF), and mitochondrial function when administered during CPR are unknown. Hypotheses: We hypothesized that administration of iNO during CPR...
Chapter
High-quality cardiopulmonary resuscitation (CPR) with targeted post-arrest management have resulted in dramatic improvements in survival with favourable neurological outcome from in-hospital paediatric cardiac arrest over the past two decades. High-quality CPR focuses on five key components: (1) chest compression depth of at least one-third of the...
Article
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: system...
Article
Full-text available
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: system...
Article
Current Medical training in India is generally didactic and pedagogical, and often does not systematically prepare newly graduated doctors to be competent, confident and compassionate. After much deliberation, the Medical Council of India (MCI) has recently introduced a new outcome-driven curriculum for undergraduate medical student training with s...
Article
Objectives: To determine timing and cause of death in children admitted to the PICU following return of circulation after out-of-hospital cardiac arrest. Design: Retrospective observational study. Setting: Single-center observational cohort study at the PICU of a tertiary-care hospital (Erasmus MC-Sophia, Rotterdam, the Netherlands) between 20...
Article
Full-text available
Objective: Develop an automated approach to detect flash (<1.0 s) or prolonged (>2.0 s) capillary refill time (CRT) that correlates with clinician judgment by applying several supervised machine learning (ML) techniques to pulse oximeter plethysmography data. Materials and methods: Data was collected in the Pediatric Intensive Care Unit (ICU), C...
Article
Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency i...
Article
Full-text available
Background Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine i...
Article
Objectives: The Heart And Lung Failure-Pediatric INsulin Titration study was experiencing poor subject enrollment due to low rates of informed consent. Heart And Lung Failure-Pediatric INsulin Titration investigators collaborated with the Perelman School of Medicine Standardized Patient Program to explore the novel use of telesimulation with stand...
Article
Objectives: Capillary refill time is a noninvasive method to assess tissue perfusion to determine shock status. Capillary refill time is defined as the time required to regain skin color after blanching pressure is applied. Although common methods to measure capillary refill time depend on clinicians' visual assessment, a new approach using a puls...
Article
Introduction Patients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus d...
Article
Objectives To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City. Study design Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020 to 9 New York City pediatric intensive care units (PICUs) with SARS-CoV-2 infection. Res...
Article
Although intraoperative emergencies are uncommon,1 we need to develop evidence‐informed and contextualized guidance for intraoperative emergencies involving patients with COVID‐19. At our academic pediatric hospital, we assembled a multi‐disciplinary team to examine and adapt intraoperative emergency workflows to ensure safety for patients with sus...
Article
Objectives: While most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with s...
Article
Objectives: Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children are not well studied. This study aims to describe prevalence and risk factors for pediatric difficult bag-mask ventilation as well as its...
Article
Objectives: Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. Design: Single-center retrospective before-after study....
Article
The American Heart Association (AHA) recommends first defibrillation energy dose of 2 joules/kilogram (J/kg) for pediatric cardiac arrest with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, optimal first energy dose remains unclear. Methods Using AHA Get With the Guidelines-Resuscitation® (GWTG-R) database, we i...
Article
Aim of the study Since over 80% of sudden cardiac arrests occur in the home, cardiopulmonary resuscitation (CPR) training for family members of high-risk cardiac patients represents a promising intervention. The use of mobile application-based (mApp) CPR training may facilitate this approach, but evidence regarding its efficacy is lacking. Methods...
Article
Full-text available
Background Several studies suggest that the outcome of pediatric cardiopul-monary resuscitation depends strongly on timely recognition of the underlying cause for cardiac arrest, the prominent ones being primary ventricular fibril-lation and secondary asphyxia-associated ventricular fibrillation. If the cause could be determined within the first mi...
Article
Statement: The International Network for Simulation-based Pediatric Innovation, Research, and Education co-hosted a novel research accelerator meeting with the International Pediatric Simulation Society in May of 2019 in Toronto. The purpose of the meeting was to bring together healthcare simulation scientists with resuscitation stakeholders to br...
Article
The surging COVID-19 pandemic has raised ethical and moral dilemmas that Western nations with first-rate medical care facilities rarely confront—how to best allocate standard life-saving medical resources when escalating demand outstrips supply. Sadly, these quandaries are familiar challenges in resource-poor countries. What makes this pandemic not...
Article
Objectives: The objective of this study was to compare survival outcomes and intra-arrest arterial blood pressures between children receiving cardiopulmonary resuscitation for bradycardia and poor perfusion and those with pulseless cardiac arrests. Design: Prospective, multicenter observational study. Setting: PICUs and cardiac ICUs of the Col...
Article
Objectives: Tracheal intubation in critically ill children with shock poses a risk of hemodynamic compromise. Ketamine has been considered the drug of choice for induction in these patients, but limited data exist. We investigated whether the administration of ketamine for tracheal intubation in critically ill children with or without shock was as...
Chapter
There is a paucity of research investigating secondary injury mechanisms specific to infants and children following cardiac arrest. This chapter focuses on pediatric cardiac arrest, cardiopulmonary resuscitation (CPR), and other therapeutic interventions that have been specifically designed to improve outcomes from pediatric cardiac arrest. The fou...