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Available from: Ricardo A Samson, Dec 10, 2015
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    • "The principal outcomes examined were: return of spontaneous circulation (ROSC); survival at 30 days, to hospital discharge, at one year and at five years or other duration post event/discharge; duration of admission; neurological and functional outcome at 30 days, at one year, five years or other duration; and, quality of life measurements. We aimed to research after the dissemination of 'Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: an international consensus on science'[4,5]and so limited our review to studies published after 2003. "
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    ABSTRACT: Cardiopulmonary arrest in children is an uncommon event, and often fatal. Resuscitation is often attempted, but at what point, and under what circumstances do continued attempts to re-establish circulation become futile? The uncertainty around these questions can lead to unintended distress to the family and to the resuscitation team.
    Full-text · Article · Jun 2015 · PLoS ONE
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    ABSTRACT: New American Heart Association Guidelines 2010 emphasize the need for high-quality CPR, which can be seen in initiating chest compressions sooner (before 2 ventilations) and with slightly modified compression depth and rate. Fundamental change in CPR sequence is abandoning A-B-C steps for C-A-B (all age groups excluding newly born) to minimise the delay in initiating chest compressions. Dispatchers should help bystanders recognize cardiac arrests and provide instructions on Hands-Only CPR. New guidelines add fifth link to the Adult Chain of Survival - "post-cardiac arrest care" and underline team approach to the resuscitation. Advanced Cardiovascular Life Support guidelines also emphasize good-quality CPR and recommend capnography for monitoring CPR quality. Atropine is no longer recommended for routine use in the treatment of pulseless electrical activity and asystole. For symptomatic bradycardia pacing is still recommended but chronotropic drug infusions should be considered an alternative. Both morphine and oxygen should be used with caution in acute coronary syndromes as they might affect the outcome. Post-cardiac arrest care after ROSC should include multidisciplinary management and often includes hypothermia.
    Full-text · Article · Jan 2011 · Wiadomości lekarskie (Warsaw, Poland: 1960)
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    ABSTRACT: To test the hypothesis that high-dose dexmedetomidine can be successfully used for pediatric magnetic resonance imaging (MRI) sedation without significant hemodynamic compromise. The dexmedetomidine dose required to achieve optimal sedation is often higher than its recommended dose. High doses of dexmedetomidine can lead to significant hemodynamic side effects. Dexmedetomidine use for pediatric MRI over a 1-year period was retrospectively reviewed. A dexmedetomidine bolus of 2 μg·kg(-1) intravenous followed by 1 μg·kg(-1)·h(-1) infusion was used. Dexmedetomidine efficacy, side effects, timing of side effects, and additional use of medications were analyzed. Data were compared by t-test, Mann-Whitney rank-sum test, Fisher's exact test, and anova. High-dose dexmedetomidine was used in 77 patients, and MRI was completed in 76 (99%) patients. A second bolus of dexmedetomidine was required in 28 (36%) patients, and 22 (29%) patients required additional medications (midazolam, fentanyl, or ketamine) for adequate sedation. A 25% decrease in blood pressure (BP) was observed in 10.5%, a transient increase in BP in 3.9%, and a heart rate <60 min(-1) in 7.9% of cases. These side effects resolved spontaneously. There were no apneas or respiratory depression. Vital sign changes, recovery time, and discharge time were not significantly different in subgroups of patients receiving one or two boluses of dexmedetomidine with or without additional medications. Transient hypertension was more common in patients receiving two boluses of dexmedetomidine (P = 0.048). High-dose dexmedetomidine can be successfully used for pediatric MRI sedation, but a significant number of children require additional medications for optimal control. Hemodynamic side effects resolved spontaneously. High-dose dexmedetomidine did not result in respiratory depression.
    No preview · Article · Feb 2011 · Pediatric Anesthesia
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