Moreno Rodolfo P, Vassallo Juan C, Sáenz Silvia S, Blanco Ana C, Allende Daniel, Araguas José L, Ayala Torales Santiago, Banille Edgardo, Berrueta Amanda M, Capocasa Patricia, Caprotta César G, Moreno Guillermo E, Pérez Hilda S, Porta Liliana, Rodríguez Gabriela, Rojo Marcelo
Unidad de Cuidados Intensivos Pediátricos, Hospital Municipal Materno Infantil de San Isidro Dr. C. Gianantonio, San Isidro.
Arch Argent Pediatr. 2010 Jun;108(3):216-25. doi: 10.1590/S0325-00752010000300007.
The cardiopulmonary resuscitation (CPR) is a common setting in the pediatric intensive care unit (PICU). There are very few reports or publications that evaluate the form of CPR administered in children.
All children with cardiopulmonary arrest who were resuscitated in the PICU between 01/04/2004- 31/03/2005. A prospective cohort study.
There were 2065 admissions in nine 9 PICU and CPR was conducted in 132 patients (6.39%). Most common etiologies of PCR were hypoxia and hypotension (65.9% of total). The initial rates of PCR were 43.94% bradycardia, asystolia 43.18%, 9.85% ventricular arrhythmias. The average beginning of time of CPR was 0.08 minutes (SD 0.25) and the average total duration was 25.91 minutes (SD 18.56). Patients who require drugs were 131. The number (mean) dose of adrenaline was 4.03 (SD 2.78). Increased number of doses of adrenaline was associated with less chance of recovery of spontaneous circulation (ROSC), OR 0.48 95% CI 0.37-0.63. (p= 0.000). The duration of CPR was inversely associated and significantly related to achieve ROSC, OR 0.93 95% CI 0.87-0.99. One hundred and four (78.79%) patients died and 28 survived. All survived were discharged from PICU, but 26 from hospital. In 22 patients there were not evidence of severe neurological damage when discharged home.
Most common etiologies of PCR were hypoxia and shock. Most children received drugs. The drugs most used were the association adrenaline-bicarbonate and adrenaline alone. The chances of recovery were not favorable when CPR was conducted for over sixty minutes or more than six doses of adrenaline were given, without response. CPR in PICU children has a high mortality. Most patients discharged from hospital, had neurological normal state or slight disability. PICU physicians were highly trained in CPR with resuscitation courses.
心肺复苏（CPR）在儿科重症监护病房（PICU）是常见情况。很少有报告或出版物评估儿童心肺复苏的实施形式。
1）确定PICU中心肺复苏的病因和流行病学情况。2）描述如何进行心肺复苏。3）描述所使用的药物。4）了解患者的预后。5）了解PICU医生的心肺复苏培训情况。
2004年4月1日至2005年3月31日期间在PICU接受复苏的所有心脏骤停儿童。一项前瞻性队列研究。
9个PICU共有2065例入院病例，132例患者（6.39%）接受了心肺复苏。心肺复苏最常见的病因是缺氧和低血压（占总数的65.9%）。心肺复苏的初始心率情况为：心动过缓占43.94%，心搏停止占43.18%，室性心律失常占9.85%。心肺复苏开始的平均时间为0.08分钟（标准差0.25），总平均持续时间为25.91分钟（标准差18.56）。需要用药的患者有131例。肾上腺素的剂量（平均）为4.03（标准差2.78）。肾上腺素剂量增加与自主循环恢复（ROSC）的机会减少相关，比值比为0.48，95%置信区间为0.37 - 0.63（p = 0.000）。心肺复苏的持续时间与实现ROSC呈负相关且显著相关，比值比为0.93，95%置信区间为0.87 - 0.99。104例（78.79%）患者死亡，28例存活。所有存活患者均从PICU出院，但有26例从医院出院。22例患者出院回家时没有严重神经损伤的证据。
心肺复苏最常见的病因是缺氧和休克。大多数儿童接受了药物治疗。最常用的药物是肾上腺素与碳酸氢盐联合使用以及单独使用肾上腺素。当心肺复苏持续超过60分钟或给予超过6剂肾上腺素且无反应时，恢复的机会不佳。PICU中儿童心肺复苏死亡率高。大多数出院患者神经状态正常或有轻微残疾。PICU医生通过复苏课程接受了心肺复苏方面的高度培训。
