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Significant factors in predicting sustained ROSC (return of spontaneous circulation) in paediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) admitted to the emergency department. By intern 9001140 李凱靈. TitleAuthor(s): (Chang Hua Hosp.)

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by intern 9001140

Significant factors in predicting sustained ROSC (return of spontaneous circulation) in paediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) admitted to the emergency department.

By intern 9001140

李凱靈

slide2
TitleAuthor(s): (Chang Hua Hosp.)
    • Yan-Ren Lin, Han-Ping Wu,Chin-Yi Huang, Yu-Jun Chang,Ching-Yuang Lin, Chu-Chung Chou
  • Source/Date/Volume/Issue: Resuscitation (2007.6.26) 74, 83—89
  • Study Design : retrospective study
  • Type : Clinical paper
introduction 1
Introduction(1)
  • Aim of study: determine predicting factors for sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma.
  • Major cause of death in OHCA children: Trauma (trauma pose challenges in resuscitation)
  • evaluate the condition and prognosis of OHCA paediatric patients with trauma.  provide appropriate managementhigher survival rates
introduction 2
Introduction (2)
  • In adults: initial cardiac rhythm, bystander BLS, a short interval from scene to hospital and early defibrillation.
  • In children: unclear
materials and methods 1
Materials and methods(1)
  • Patient population:115, <18y/o, Jan2000-Dec2004 (Chang Hua Hosp.)
    • Traumatic:56 (traffic accidents, falls, child abuse)
    • Non-traumatic:59
  • Methods:
    • prehospital info from EMS
    • Present to EDAPLS (advanced paediatric life support)
    • Sustained ROSC: when chest compressions were not required for 20 consecutives minutes and signs of a circulation persist
materials and methods 2
Materials and methods(2)
  • Analysed factors:
    • (1) demographic data gathered from the ED sheets including initial vital signs, age, and sex
    • (2) mode of transportation (family, EMTs)
    • (3) the period from scene to hospital (callarrived ED)
    • (4) whether pre-hospital BLS had been performed
    • (5) initial cardiac rhythm on presentation to the ED (PEA, VF include pulses VT, asystole)
    • (6) the main site of trauma (H&N, T, Abd,multiple)
    • (7) type of trauma (blunt or penetrating trauma)
    • (8) the duration of in-hospital CPR
materials and methods 3
Materials and methods(3)
  • Statistical methods:
    • %, mean±S.D., median, logistic regression analysis - to select independent predictors to dichotomous dependent variables between sustained ROSC and non-sustained ROSC patients
    • Log Rank test and 95% CI - compare the difference between trauma and non-trauma groups
    • ROC curve – determined the best duration of in-hospital CPR
  • P-value < 0.05
results 1

sustained ROSC was obtained in 20 OHCA patients, but only one (spleen laceration+massive internal bleeding) eventually discharged from hospital

-->percentage of sustained ROSC :35.7%

-->total mortality rate:98.2%

Results(1)

Head and neck injury (majority in trauma group),

survival rate is very low , but 35.7% regained sustained ROSC

-->possible organ donation (sustained ROSC is necessary to prevent organ failure before surgical intervention)

-->thus, 2 survey (thorough head-to-toe)should be performed rapidly after 1 survey

-->X-ray , CT scan for accurate diagnosis without delay after brief neurologial examination

results 2
Results (2)

Initially cardiac rhythm:

asystole>PEA>VF

success rate of initial CPR:

PEA>VF>asystole

Survival rate of paediatric patients with cardiac arrest secondary to trauma is poor, especially in patients with head and thoracic injury.

results 3
Results (3)

1.Initial cardiac rhythm and the duration of in-hospital CPR were the most significant factors associated with sustained ROSC .

2.The success rate of initial CPR was higher in patients with PEA (P = 0.003) and VF (P = 0.03) than in patients with asystole

3.PEA and VF were better predictors of successful CPR outcome than asystole

-->accuracy and speed in reading the ECG and providing the appropriate management (for example, CPR in asystole or PEA; early defibrilation in VF or pulseless VT)

results 4
Results (4)

Survival analysis: OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008)

  • Two survival curves fell once the period was prolonged, especially in the trauma group(P=0.008).
  • Decreasing the period from scene to hospital may improve the sustained ROSC rate in the ED, especially in OHCA children with trauma.
results 5
Results (5)

However, clinically, some patients in the study received >25min of in-hospital CPR and regained sustained ROSC

Thus, in-hospital CPR may have to be performed for atleast 25 min to enable a spontaneous circulation to return

  • The best cut-off duration of in-hospital CPR was 25 min (CI:0.769-0.953)
  • Sens : 90% (patients with sustained ROSC, CPR was performed in-hospital for <25min)
  • Spec : 86% ( patients without sustained ROSC do not return to achieve ROSC even after >25min)