![]() 4– 7 Table 1 shows a comparison of these variables between pediatric and adult patients. 3Ĭompared with adults with IHCA, children with IHCA differ in demographic characteristics, location within the hospital, cause of cardiac arrest, initial cardiac arrest rhythm, and type of monitoring in place. However, survival rates have plateaued and more than half of children with IHCA do not survive to hospital discharge. 1 Pediatric IHCA outcomes improved during the first decade of the 21st century, 2, 3 likely owing to a widespread recognition of the need for high-quality resuscitation and a focus on recognizing and transferring the deteriorating pediatric inpatient to an intensive care unit (ICU). Structured post–cardiac arrest care focused on targeted temperature management, optimization of hemodynamics, and careful intensive care unit management is associated with improved survival and neurological outcomes.Īn estimated 15 200 children receive cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest (IHCA) annually in the United States. Extracorporeal CPR and measurement of physiological parameters are evolving areas in improving outcomes. Important components of CPR include high-quality chest compressions, timely defibrillation when indicated, appropriate ventilation and airway management, administration of epinephrine to increase coronary perfusion pressure, and treatment of the underlying cause of cardiac arrest. Pre–cardiac arrest systems focus on identifying at-risk patients and ensuring that they are in monitored settings. Bradycardia with poor perfusion is the initial rhythm in half of CPR events, and only about 10% of events have an initial shockable rhythm. Most IHCAs occur in intensive care units and other monitored settings and are associated with respiratory failure or shock. ![]() As many as 80% to 90% survive the event, but most patients do not survive to hospital discharge. Aim to save a life.Each year, more than 15 000 children receive CPR for cardiac arrest during hospitalization in the United States. The app is free and can be downloaded here. An app that is highly helpful in calculating CCF is Full Code Pro from the AHA. Supporting these metrics has been shown to improve patient outcomes greatly. In summary, adhere to the performance standards of high-quality CPR, aim for an EtCO2 of at least 10 mmHg and a CPP of at least 20 mmHg during chest compressions, and maximize CCF to a level of greater than 80% during team-based resuscitations. Resuscitations can be chaotic, which is why team members must work together fluently and understand the complex nature of the cardiac arrest. Increase CCF by integrating practices like pre-charging the defibrillator, hovering over the patient’s chest during pauses if performing compression duties, and ensuring compressor switches are performed swiftly and efficiently. A perfused myocardium is more responsive to medications and electrical therapies. Minimize pauses in chest compressions to increase CCF and return CPP to an adequate level, which ensures the myocardium is perfused. This metric incentivizes rescuers to maximize CCF. While CCF is just one component of a successful resuscitation, the ROC found that for every 10% increase in CCF, there was an increase in survival of 11% (Sinz, 2020). The AHA recommends a CCF greater than 60% for single-rescuer situations and greater than 80% for team-based situations (Sinz, 2020). To calculate CCF you must divide the total amount of time spent performing chest compressions by the total resuscitation time. Chest compression fraction is a measure of time, specifically, the percentage of time during a resuscitation spent performing chest compressions. It is reasonable to expect improved patient outcomes when EtCO2 is above 10 mmHg, and coronary perfusion pressure (CPP) is greater than 20 mmHg (Sinz, 2020).ĬCF is shorthand for chest compression fraction. Maximize resuscitation efforts by adhering to the above performance standards. Regardless of the setting, the success of resuscitation efforts was directly attributed to the quality of CPR delivered. The ROC found that there is wide variability in patient survival, which was studied in both animal and clinical settings. Pauses between compressions no greater than 10 secondsĪvoidance of excessive ventilation (Sinz, 2020) The AHA defines CPR as high-quality if it meets the following criteria:Ĭompression depth: 2 inches for Adults and children, 1-1/2 inches for infants.Ĭompression rate: 100-120 compressions per minuteĬompression to breath ratio: 30:2 (1 rescuer for adults, children, and infants), 15:2 (2-rescuer for children and infants) *continuous compressions with the presence of an advanced airway
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