Despite advances in resuscitation science and survival improvement over the last decades, survival remains low, with only approximately 38% of children surviving to hospital discharge after p-IHCA, and 6%-20% after p-OHCA. Pediatric out-of-hospital cardiac arrest (p-OHCA) accounts for a further 7037 children brought to US PEDs by emergency medical services each year. Recent studies show that pediatric in-hospital cardiac arrest (p-IHCA) affects 7100-8300 children per year in the United States, of which 14% occur in pediatric emergency departments (PEDs). It requires immediate recognition and care by skilled health providers.
Pediatric cardiac arrest is a high-risk, low-frequency event associated with death or severe neurological sequelae in survivors. These errors were reduced to 1% (1/78, P=.005) when using the app.Ĭonclusions: Use of the mobile app was associated with a shorter time to first and subsequent defibrillation attempts, fewer medication and defibrillation dose errors, and improved adherence to AHA recommendations compared with the use of PALS pocket cards. Among a total of 78 opportunities, incorrect shock or drug doses occurred in 14% (11/78) of cases among those using the cards. Time to epinephrine injection was similar. The pVT rhythm was recognized correctly in 51 out of 52 (98%) opportunities among residents using the app compared to only 19 out of 52 (37%) among those using PALS cards ( P<.001). Adherence to the 2018 AHA pVT algorithm improved by approximately 70% ( P=.001) when using the app following all CPR sequences of action in a stepwise fashion until return of spontaneous circulation. Time to all other defibrillation attempts was reduced with the app. With the app, 11 out of 13 (85%) residents initiated chest compressions within 60 seconds from the onset of pVT and 12 out of 13 (92%) successfully defibrillated within 180 seconds. Results: Mean time to the first defibrillation attempt (121.4 sec, 95% CI 105.3-137.5) was significantly reduced among residents using the app compared to those using PALS pocket cards (211.5 sec, 95% CI 162.5-260.6, P<.001).
All outcomes were assessed for deviation from AHA guidelines. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, including the time intervals between defibrillation attempts and drug doses, shock doses, and the number of shocks. The primary outcome was the elapsed time in seconds in each allocation group from the onset of pVT to the first defibrillation attempt. A total of 26 pediatric residents were randomized into two groups.
Cpr aha standards trial#
Methods: This study was a randomized controlled trial conducted during a simulation-based pediatric cardiac arrest scenario caused by pulseless ventricular tachycardia (pVT). Objective: We investigated whether a mobile app developed as a guide to support and drive CPR providers in real time through interactive pediatric advanced life support (PALS) algorithms would increase adherence to AHA guidelines and reduce the time to initiation of critical life-saving maneuvers compared to the use of PALS pocket reference cards. Despite advances in resuscitation science and survival improvement over the last decades, only approximately 38% of children survive to hospital discharge after in-hospital cardiac arrest and only 6%-20% after out-of-hospital cardiac arrest. Adherence to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. JMIR Perioperative Medicine 38 articlesĭepartment of Pediatric Emergency MedicineĮmail: Evidence-based best practices are the cornerstone to guide optimal cardiopulmonary arrest resuscitation care.JMIR Biomedical Engineering 42 articles.Journal of Participatory Medicine 57 articles.JMIR Rehabilitation and Assistive Technologies 114 articles.JMIR Pediatrics and Parenting 117 articles.Interactive Journal of Medical Research 207 articles.
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