aDepartment of Emergency Medicine, Denver Health Medical Center, Denver, Colorado bDepartment of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado cDepartments of Emergency Medicine, Internal Medicine, School of Public Health and Office of Health System Affairs, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Curr Opin Crit Care. 2017 Jun;23(3):193-198. doi: 10.1097/MCC.0000000000000410.
To present advancements in pediatric cardiac arrest research, highlighting articles most relevant to clinical practice published since the latest international guidelines for cardiopulmonary resuscitation (CPR).
Clinical trials examining targeted temperature management in children support avoidance of hyperthermia for both pediatric in-hospital cardiac arrest (PIHCA) and out-of-hospital cardiac arrest (POHCA), but no statistically significant outcome differences were confirmed comparing 33 and 36 °C in the limited populations studied. Retrospective analyses of population-based POHCA registries revealed several associations: both bystander CPR and public-access defibrillation were associated with improved POHCA outcomes; conflicting results overshadow the benefits of conventional versus compression-only CPR; extracorporeal CPR was associated with improved PIHCA outcomes regardless of cause; intubation in PIHCA was associated with decreased survival, whereas there were no significant differences in outcomes between advanced airway management and bag-valve-mask ventilation in POHCA; and early epinephrine delivery in nonshockable rhythms during PIHCA was associated with improved outcomes. Length, age, and weight-based dosing systems can reduce time to medication delivery, quantitative errors, and anxiety among care providers.
Mounting evidence continues to align management priorities for resuscitation of children and adults.
介绍儿科心搏骤停研究的进展，重点介绍自心肺复苏（CPR）最新国际指南发布以来发表的与临床实践最相关的文章。
在对儿童进行目标体温管理的临床试验中，支持避免高热，无论是在院内心搏骤停（PIHCA）还是院外心搏骤停（POHCA），但在研究的有限人群中，比较 33°C 和 36°C 并没有确认统计学上显著的结果差异。基于人群的 POHCA 注册研究的回顾性分析揭示了几个关联：旁观者心肺复苏和公众可获得的除颤都与改善 POHCA 结局相关；传统与单纯按压心肺复苏的利弊存在冲突结果；体外心肺复苏与改善 PIHCA 结局相关，无论病因如何；PIHCA 中的插管与存活率降低相关，而在 POHCA 中，高级气道管理和球囊面罩通气之间的结果没有显著差异；在 PIHCA 中的非颤动手律中早期给予肾上腺素与改善结局相关。基于长度、年龄和体重的给药系统可以减少给药时间、定量误差和护理人员的焦虑。
越来越多的证据继续调整儿童和成人复苏的管理重点。
