Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Department of Pediatrics, Columbia University, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
Pediatr Crit Care Med. 2020 Sep;21(9):e651-e660. doi: 10.1097/PCC.0000000000002512.
While most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with suspected/confirmed coronavirus disease 2019 are unknown.
Multi-institutional survey regarding inpatient resuscitation practices during the coronavirus disease 2019 pandemic.
Internet-based survey.
U.S. PICU representatives (one per institution) involved in resuscitation system planning and oversight.
None.
Of 130 institutions surveyed, 78 (60%) responded. Forty-eight centers (62%) had admitted coronavirus disease 2019 patients; 26 (33%) reported code team activation for patients with suspected/confirmed coronavirus disease 2019. Sixty-seven respondents (86%) implemented changes to inpatient emergency response systems. The most common changes were as follows: limited number of personnel entering patient rooms (75; 96%), limited resident involvement (71; 91%), and new or refined team roles (74; 95%). New or adapted technology is being used for coronavirus disease 2019 resuscitations in 58 centers (74%). Most institutions (57; 73%) are using enhanced personal protective equipment for all coronavirus disease 2019 resuscitation events; 18 (23%) have personal protective equipment policies dependent on the performance of aerosol generating procedures. Due to coronavirus disease 2019, most respondents are intubating earlier during cardiopulmonary resuscitation (56; 72%), utilizing video laryngoscopy (67; 86%), pausing chest compressions during laryngoscopy (56; 72%), and leaving patients connected to the ventilator during cardiopulmonary resuscitation (56; 72%). Responses were varied regarding airway personnel, prone cardiopulmonary resuscitation, ventilation strategy during cardiopulmonary resuscitation without an airway in place, and extracorporeal cardiopulmonary resuscitation. Most institutions (46; 59%) do not have policies regarding limitations of resuscitation efforts in coronavirus disease 2019 patients.
Most U.S. pediatric institutions rapidly adapted their resuscitation systems and practices in response to the coronavirus disease 2019 pandemic. Changes were commonly related to team members and roles, personal protective equipment, and airway and breathing management, reflecting attempts to balance quality resuscitation with healthcare provider safety.
虽然大多数儿童 2019 年冠状病毒病病例不会危及生命，但有些儿童患有严重疾病，需要紧急复苏干预。复苏事件会对医疗保健提供者的安全构成风险，并有可能影响患者的护理。目前尚不清楚针对疑似/确诊 2019 年冠状病毒病儿童的复苏实践和政策。
一项关于 2019 年冠状病毒病大流行期间住院复苏实践的多机构调查。
基于互联网的调查。
参与复苏系统规划和监督的美国儿科重症监护病房代表（每家机构一名）。
无。
在接受调查的 130 家机构中，有 78 家（60%）做出了回应。48 家中心（62%）收治了 2019 年冠状病毒病患者；26 家（33%）报告了对疑似/确诊 2019 年冠状病毒病患者的代码团队激活。67 名应答者（86%）对住院紧急反应系统进行了更改。最常见的更改如下：限制进入患者房间的人员数量（75 人；96%）、限制住院医师参与（71 人；91%）和新的或细化的团队角色（74 人；95%）。58 家中心（74%）正在使用新的或适应的技术进行 2019 年冠状病毒病复苏。大多数机构（57 家；73%）正在为所有 2019 年冠状病毒病复苏事件使用增强型个人防护设备；18 家（23%）有根据是否进行气溶胶产生程序而定的个人防护设备政策。由于 2019 年冠状病毒病，大多数应答者在心肺复苏期间更早地进行插管（56 人；72%）、使用视频喉镜（67 人；86%）、在喉镜检查期间暂停胸部按压（56 人；72%）和在心肺复苏期间让患者连接呼吸机（56 人；72%）。在气道人员、俯卧位心肺复苏、无气道时心肺复苏期间的通气策略以及体外心肺复苏等方面，应答者的回答各不相同。大多数机构（46 家；59%）没有关于 2019 年冠状病毒病患者复苏努力限制的政策。
大多数美国儿科机构迅速调整了复苏系统和实践，以应对 2019 年冠状病毒病大流行。这些变化通常与团队成员和角色、个人防护设备以及气道和呼吸管理有关，反映了在平衡高质量复苏与医疗保健提供者安全方面的努力。
