Paediatric cardiac arrest prognostication in the context of a HEMS service

Benjamin Stretch
{"title":"Paediatric cardiac arrest prognostication in the context of a HEMS service","authors":"Benjamin Stretch","doi":"10.1186/s13049-024-01174-5","DOIUrl":null,"url":null,"abstract":"<p>Many thanks to Fuchs et al. for publishing their retrospective study looking at neurological outcome following out of hospital paediatric cardiac arrest, which showed a high rate of positive neurological outcome (19%) [1].</p><p>Firstly, when looking at prognostic factors, I believe traumatic and non-traumatic cardiac arrest should be analysed separately. This is emphasised by the significant difference in survival shown in this study (OR 11.07), a different treatment algorithm recommended by the European Resuscitation Council and a focus on different reversible causes [2]. For example, there is some debate over the role of chest compressions in traumatic cardiac arrest– bystander CPR and adrenaline may have limited prognostic value in the context of severe hypovolaemia, tension pneumothorax or cardiac tamponade. As a result, we may find that the positive neurological predictors in trauma may differ to those identified overall in this study.</p><p>This study is a cohort of HEMS patients resulting in a higher number of traumatic cardiac arrests in rural locations which is not representative of all cause paediatric arrests. As expected, a key predictor of neurological outcome seems to be time. Both direct measures (response time / time to BLS &gt; 2 min) and indirect measures (ongoing CPR at HEMS arrival / adrenaline doses) of low-flow and no-flow time seem to correlate closely with neurological outcome. This study raises the question of the exact role of HEMS in the management of cardiac arrest, where early basic intervention rather than complex advanced treatments deliver the best prognostic value. HEMS teams can deliver advanced interventions which may be of additional value optimising physiology after return of spontaneous circulation. Different interventions are required in traumatic cardiac arrest which may be beyond the scope of paramedic teams. In some systems, there may also be a time advantage– both in delivering care to the patient (for example in rural areas) and delivering the patient to definitive care.</p><p>It is important to emphasize that early bystander CPR was an important prognostic factor, with 33% of patients in this study not receiving this. This is an excellent reminder of the importance of education, particularly in the context of paediatrics. An example of this includes the Resuscitation Council United Kingdom’s ‘Aaron’s Heart’ - a free educational book on paediatric resuscitation, produced in response to a survey showing that only 15% parents would recognise if their child was in cardiac arrest [3]. </p><p>No data presented.</p><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Fuchs A, Bockemuehl D, Jegerlehner S, et al. Favourable neurological outcome following paediatric out-of-hospital cardiac arrest: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2023;31:106.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"2.\"><p>Lott C, Truhlar A, Alfonzo A et al. European Resuscitation Council Guidelines. 2021: Cardiac Arrest in special circumstances. <i>Resuscitation (2021)</i>.</p></li><li data-counter=\"3.\"><p>Resuscitation Council United Kingdom.– RCUK releases free baby and child CPR book. Aaron’s Heart (2023) https://www.resus.org.uk/about-us/news-and-events/rcuk-releases-free-baby-and-child-cpr-book-aarons-heart.</p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>Not applicable.</p><p>No funding obtained.</p><h3>Authors and Affiliations</h3><ol><li><p>Queen Mary University, London, UK</p><p>Benjamin Stretch</p></li></ol><span>Authors</span><ol><li><span>Benjamin Stretch</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Contributions</h3><p>BS prepared the manuscript. All authors have approved the manuscript.</p><h3>Corresponding author</h3><p>Correspondence to Benjamin Stretch.</p><h3>Ethics approval and consent to participate</h3>\n<p>Not required.</p>\n<h3>Consent for publication</h3>\n<p>Not required.</p>\n<h3>Competing interests</h3>\n<p>BS is a member of the Resuscitation Council United Kingdom’s Paediatric Subcommittee. This is a voluntary role with no financial interests.</p><h3>Publisher’s Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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Paediatric cardiac arrest prognostication in the context of a HEMS service. <i>Scand J Trauma Resusc Emerg Med</i> <b>32</b>, 3 (2024). https://doi.org/10.1186/s13049-024-01174-5</p><p>Download citation<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><ul data-test=\"publication-history\"><li><p>Received<span>: </span><span><time datetime=\"2024-01-04\">04 January 2024</time></span></p></li><li><p>Accepted<span>: </span><span><time datetime=\"2024-01-05\">05 January 2024</time></span></p></li><li><p>Published<span>: </span><span><time datetime=\"2024-01-22\">22 January 2024</time></span></p></li><li><p>DOI</abbr><span>: </span><span>https://doi.org/10.1186/s13049-024-01174-5</span></p></li></ul><h3>Share this article</h3><p>Anyone you share the following link with will be able to read this content:</p><button data-track=\"click\" data-track-action=\"get shareable link\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Get shareable link</button><p>Sorry, a shareable link is not currently available for this article.</p><p data-track=\"click\" data-track-action=\"select share url\" data-track-label=\"button\"></p><button data-track=\"click\" data-track-action=\"copy share url\" data-track-external=\"\" data-track-label=\"button\" type=\"button\">Copy to clipboard</button><p> Provided by the Springer Nature SharedIt content-sharing initiative </p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s13049-024-01174-5","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract

Many thanks to Fuchs et al. for publishing their retrospective study looking at neurological outcome following out of hospital paediatric cardiac arrest, which showed a high rate of positive neurological outcome (19%) [1].

Firstly, when looking at prognostic factors, I believe traumatic and non-traumatic cardiac arrest should be analysed separately. This is emphasised by the significant difference in survival shown in this study (OR 11.07), a different treatment algorithm recommended by the European Resuscitation Council and a focus on different reversible causes [2]. For example, there is some debate over the role of chest compressions in traumatic cardiac arrest– bystander CPR and adrenaline may have limited prognostic value in the context of severe hypovolaemia, tension pneumothorax or cardiac tamponade. As a result, we may find that the positive neurological predictors in trauma may differ to those identified overall in this study.

This study is a cohort of HEMS patients resulting in a higher number of traumatic cardiac arrests in rural locations which is not representative of all cause paediatric arrests. As expected, a key predictor of neurological outcome seems to be time. Both direct measures (response time / time to BLS > 2 min) and indirect measures (ongoing CPR at HEMS arrival / adrenaline doses) of low-flow and no-flow time seem to correlate closely with neurological outcome. This study raises the question of the exact role of HEMS in the management of cardiac arrest, where early basic intervention rather than complex advanced treatments deliver the best prognostic value. HEMS teams can deliver advanced interventions which may be of additional value optimising physiology after return of spontaneous circulation. Different interventions are required in traumatic cardiac arrest which may be beyond the scope of paramedic teams. In some systems, there may also be a time advantage– both in delivering care to the patient (for example in rural areas) and delivering the patient to definitive care.

It is important to emphasize that early bystander CPR was an important prognostic factor, with 33% of patients in this study not receiving this. This is an excellent reminder of the importance of education, particularly in the context of paediatrics. An example of this includes the Resuscitation Council United Kingdom’s ‘Aaron’s Heart’ - a free educational book on paediatric resuscitation, produced in response to a survey showing that only 15% parents would recognise if their child was in cardiac arrest [3].

No data presented.

  1. Fuchs A, Bockemuehl D, Jegerlehner S, et al. Favourable neurological outcome following paediatric out-of-hospital cardiac arrest: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2023;31:106.

    Article PubMed PubMed Central Google Scholar

  2. Lott C, Truhlar A, Alfonzo A et al. European Resuscitation Council Guidelines. 2021: Cardiac Arrest in special circumstances. Resuscitation (2021).

  3. Resuscitation Council United Kingdom.– RCUK releases free baby and child CPR book. Aaron’s Heart (2023) https://www.resus.org.uk/about-us/news-and-events/rcuk-releases-free-baby-and-child-cpr-book-aarons-heart.

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    Benjamin Stretch

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BS prepared the manuscript. All authors have approved the manuscript.

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BS is a member of the Resuscitation Council United Kingdom’s Paediatric Subcommittee. This is a voluntary role with no financial interests.

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Stretch, B. Paediatric cardiac arrest prognostication in the context of a HEMS service. Scand J Trauma Resusc Emerg Med 32, 3 (2024). https://doi.org/10.1186/s13049-024-01174-5

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急救服务中的儿科心脏骤停预后分析
Reprints and permissionsCite this articleStretch, B. Paediatric cardiac arrest prognostication in the context of a HEMS service.Scand J Trauma Resusc Emerg Med 32, 3 (2024). https://doi.org/10.1186/s13049-024-01174-5Download citationReceived:04 January 2024Accepted:05 January 2024Published: 22 January 2024DOI: https://doi.org/10.1186/s13049-024-01174-5Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative.
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