There is increasing recognition that systematic post–cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life. This is based in part on the publication of results of randomized controlled clinical trials as well as a description of the post–cardiac arrest syndrome. 1–3 Post–cardiac arrest care has significant potential to reduce early mortality caused by hemodynamic instability and later morbidity and mortality from multiorgan failure and brain injury. 3,4 This section summarizes our evolving understanding of the hemodynamic, neurological, and metabolic abnormalities encountered in patients who are initially resuscitated from cardiac arrest. The initial objectives of post–cardiac arrest care are to ● Optimize cardiopulmonary function and vital organ perfusion. ● After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post–cardiac arrest treatment system of care that includes acute coronary interventions, neurological care, goal-directed critical care, and hypothermia. ● Transport the in-hospital post–cardiac arrest patient to an appropriate critical-care unit capable of providing comprehensive post–cardiac arrest care. ● Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest.

http://www.kardio.hu/feltoltott/dokumentumok/fajl_201148104747Cardiopulm_resuscit_Pt9_Post_cardiac.pdf

Part 9: Post-Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

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Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause. More often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest. Asphyxia begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis, progresses to bradycardia and hypotension, and culminates with cardiac arrest.1

Another mechanism of cardiac arrest, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), is the initial cardiac rhythm in approximately 5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests;2,–,9 it is reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation.6 The incidence of VF/pulseless VT cardiac arrest rises with age.2,4 Increasing evidence suggests that sudden unexpected death in young people can be associated with genetic abnormalities in myocyte ion channels resulting in abnormalities in ion flow (see “Sudden Unexplained Deaths,” below).

Since 2010 marks the 50th anniversary of the introduction of cardiopulmonary resuscitation (CPR),10 it seems appropriate to review the progressive improvement in outcome of pediatric resuscitation from cardiac arrest. Survival from in-hospital cardiac arrest in infants and children in the 1980s was around 9%.11,12 Approximately 20 years later, that figure had increased to 17%,13,14 and by 2006, to 27%.15,–,17 In contrast to those favorable results from in-hospital cardiac arrest, overall survival to discharge from out-of-hospital cardiac arrest in infants and children has not changed substantially in 20 years and remains at about 6% (3% for infants and 9% for children and adolescents).7,9

It is unclear why the improvement in outcome from in-hospital cardiac arrest has occurred, although earlier recognition and management of at-risk patients on general inpatient units …

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.110.971101

Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Objective:This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.Background:It builds o...

/pdf/a-review-of-the-research-literature-on-evidence-based-2oeftve5sd.pdf

A Review of the Research Literature on Evidence-Based Healthcare Design

European Resuscitation Council Guidelines for Resuscitation 2015

ObjectivesTo compare propofol with ketamine sedation delivered by pediatric intensivists during painful procedures in the pediatric critical care department (PCCD).DesignProspective 15-month study.SettingAn 18-bed multidisciplinary, university-affiliated PCCD.InterventionsAll children were randomize

Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care

Honey has been described in ancient and modern medicine as being effective in the healing of various infected wounds. In this report we present our experience in nine infants with large, open, infected wounds that failed to heal with conventional treatment. Conventional treatment was defined as having failed if after > or = 14 d of intravenous antibiotic and cleaning the wound with chlorhexidine 0.05% W/V in aqueous solution and fusidic acid ointment the wound was still open, oozing pus, and swab cultures were positive. All infants showed marked clinical improvement after 5 d of treatment with topical application of 5-10 ml of fresh unprocessed honey twice daily. The wounds were closed, clean and sterile in all infants after 21 d of honey application. There were no adverse reactions to the treatment. We conclude that honey is useful in the treatment of post-surgical wounds that are infected and do not respond to conventional systemic and local antibiotic treatment.

Local application of honey for treatment of neonatal postoperative wound infection.

Simulation-based medical education (SBME) is a rapidly growing field, as is illustrated by the increased development of simulation centers worldwide. SBME is becoming a powerful force in addressing the need to increase patient safety through quality-care training. Recognizing the benefits of SBME, increasing numbers of bodies involved in medical and health care education and training are establishing simulation centers worldwide. The general model of most facilities focuses on a single simulation modality or a specific branch of medicine or health care, limiting their overall impact on patient safety and quality of care across the health care systems. MSR, the Israel Center for Medical Simulation, is a comprehensive, national, multimodality, multidisciplinary medical simulation center dedicated to enhancing hands-on medical education, performance assessment, patient safety, and quality of care by improving clinical and communication skills. The center uses an "error-driven" educational approach, which recognizes that errors provide an opportunity to create a unique beneficial learning experience. The authors present the Israeli experience as an alternative model, and describe the impact of the MSR model on the Israeli medical community during four years of activity. They also describe the opportunities this model has opened towards changing the culture of medical education and patient safety within Israel Although this model may require modification when implemented in other medical systems, it highlights important lessons regarding the power of SBME in triggering and bringing about cultural changes in traditional medical education.

The Israel Center for Medical Simulation: a paradigm for cultural change in medical education.

PURPOSE Children with malignancies in whom life-threatening complications develop are traditionally considered as having a grim prognosis. Clinical predictors of short-term outcome for rational triage to pediatric intensive care units (PICU) were retrospectively assessed. PATIENTS AND METHODS The records of 94 children consecutively admitted to the PICU at the authors' institution between January 1989 and January 1999 were reviewed, and predictors of 30-day mortality rates were delineated using stepwise logistic regression. RESULTS The children's mean age was 7.3 years (range, 2-21). Their diseases included hematologic malignancies 45 (48%), extracranial solid tumors 21 (22%), and intracranial tumors 28 (30%). The overall 30-day survival rate was 66%. Mortality was highest among children admitted for respiratory failure (40%). High mortality was also found for those with circulatory collapse (33.3%) and neurologic deterioration (31%). The admitting pediatric risk of mortality score (PRISM) among the survivors was 6.6 +/- 1.3, compared with 15.2 +/- 3 among nonsurvivors (P < 0.01). The number of organ system failures was higher among the nonsurvivors on admission (P < 0.001). The need for ventilatory or inotropic support corresponded to worse outcome (P < 0.001 or P < 0.01, respectively). Overall, 36 (38%) of the children had sepsis during their PICU stay, with a mortality rate of 50% compared with 24% among nonseptic children (P < 0.01). Sepsis present on admission was later correlated with the development of organ system failure (P < 0.01). CONCLUSIONS New trends in therapeutic approaches to children with malignancies can clearly improve outcome. The high (66%) survival rate justifies policy of early admission to the PICU of children in whom signs of multiorgan involvement start to develop, as reflected by high PRISM and the need for ventilatory or inotropic support. Further refinement of reliable clinical predictors of survival will enable better triage of these children to the PICU for possible prevention of systemic complications and reduction of mortality rates.

Predictors of outcome in the pediatric intensive care units of children with malignancies.

Objective:Arginine vasopressin was found in experimental and clinical studies to have a beneficial effect in cardiopulmonary resuscitation. The American Heart Association 2000 guidelines recommended its use for adult ventricular fibrillation arrest, and the American Heart Association 2005 guidelines

Amir Vardi

Papers

Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care

Local application of honey for treatment of neonatal postoperative wound infection.

The Israel Center for Medical Simulation: a paradigm for cultural change in medical education.

Predictors of outcome in the pediatric intensive care units of children with malignancies.

Beneficial effects of terlipressin in prolonged pediatric cardiopulmonary resuscitation: a case series.