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By intern 9001140 李凱靈

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 李凱靈

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  1. 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

  2. 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

  3. 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

  4. Introduction (2) • In adults: initial cardiac rhythm, bystander BLS, a short interval from scene to hospital and early defibrillation. • In children: unclear

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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)

  11. 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.

  12. 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)

  13. THE END! THANKS!

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