Abstract
Purpose
Evaluate the efficacy of advanced life support interventions using the pediatric Utstein guidelines.
Methods
Charts from all patients for whom a cardiorespiratory arrest code was called during a six-year period in a university affiliated centre were reviewed. Data were recorded according to the pediatric Utstein guidelines and aP < 0.05 was considered significant.
Results
Of the 234 calls, 203 were retained for analysis. The overall survival rate at one year was 26.0% of which 10% had deterioration of their neurologic status compared to the pre-cardiorespiratory arrest evaluation. Time to achieve sustained return of spontaneous circulation (ROSC;P < 0.0001) and sustained measurable blood pressure (P = 0.002), to perform endotracheal intubation (P = 0.04) and the dose of sodium bicarbonate (P < 0.0001) were indicators of long-term survival. Two patients were alive at one year with unchanged neurologic status despite a time to achieve sustained ROSC longer than 30 min (38 and 44 min). The mean first epinephrine dose of patients for whom ROSC was achieved but unsustained was higher than those for whom ROSC was achieved and sustained (0.038 ± 0.069 mg·kg−1 vs 0.01 1 ± 0.006 mg·kg−1; P = 0.004). Survival rate and mean first epinephrine dose of patients who received their first epinephrine dose endotracheally(13.3%; 0.01 1 ± 0.004 mg·kg−1) were comparable to those of patients who received their first epinephrine dose intravenously (7%; 0.015 ± 0.027 mg·kg−1).
Conclusions
For intravenously administered epinephrine, a dose of 0.01 mg·kg−1 seems appropriate as the first dose. The endotracheal route is a valuable alternative for epinephrine administration and, for infants, the dose does not need to be increased. A minimal resuscitation duration time of 30 min can be misleading if ROSC is used as the indicator.
Résumé
Objectif
Évaluer l’efficacité des interventions de réanimation cardiorespiratoire avancée à l’aide de la technique Utstein pédiatrique.
Méthode
Les dossiers de tous les enfants pour lesquels un appel de réanimation cardiorespiratoire a été demandé sur une période de six années consécutives dans un centre hospitalier universitaire ont été revus. Les données ont été recueillies selon la technique Utstein pédiatrique. Un P < 0,05 a été retenu.
Résultats
Des 234 appels, 203 ont été retenus pour analyse. Le taux de survie globale à un an est de 26,0 % avec 10% de détérioration neurologique chez les survivants. Le délai pour l’obtention de la récupération d’une activité circulatoire spontanée (ROSC; P < 0,0001) et d’une pression artérielle mesurable soutenue (P = 0,002), pour réaliser l’intubation trachéale (P = 0,04) et la dose de bicarbonate de sodium (P < 0,0001) sont des indicateurs de survie à long terme. Deux patients sont vivants un an après l’arrêt sans modification de statut neurologique malgré un délai pour le ROSC supérieur à 30 min (38 et 44 min). La dose moyenne d’adrénaline administrée comme première dose est plus élevée pour les patients avec ROSC obtenu mais non soutenu que ceux pour qui le ROSC est soutenu (0,038 ± 0,069 mg·kg−1 vs 0,011 ± 0,006 mg·kg−1; P = 0,004). Le taux de survie et la première dose d’adrénaline des patients qui ont reçu l’adrénaline par voie intratrachéale (13,3 %; 0,011 ± 0,004 mg·kg−1) sont similaires à ceux qui l’ont reçue par voie iv (7 %; 0,015 ± 0,027 mg·kg−1).
Conclusions
Une dose de 0,01 m·kg−1 d’adrénaline est appropriée comme première dose par voie iv. La voie intratrachéale est une solution de rechange adéquate et, pour les moins d’un an, la dose peut être identique à la dose recommandée pour la voie iv. Un temps minimal de réanimation de 30 min peut être insuffisant si le ROSC est choisi comme paramètre.
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Guay, J., Lortie, L. An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests. Can J Anesth 51, 373–378 (2004). https://doi.org/10.1007/BF03018242
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DOI: https://doi.org/10.1007/BF03018242