Fernandez Richard P, McConnell Patrick I, Reeder Ron W, Alvey Jessica S, Berg Robert A, Meert Kathleen L, Morgan Ryan W, Nadkarni Vinay M, Wolfe Heather A, Sutton Robert M, Yates Andrew R
Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Resusc Plus. 2024 Sep 11;20:100765. doi: 10.1016/j.resplu.2024.100765. eCollection 2024 Dec.
Patients with underlying cardiac disease form a considerable proportion of pediatric patients who experience in-hospital cardiac arrest. In pediatric patients after cardiac surgery, CPR with abdominal compressions alone (AC-CPR) may provide an alternative to standard chest compression CPR (S-CPR) with additional procedural and physiologic advantages.
Quantitatively describe hemodynamics during cardiopulmonary resuscitation (CPR) and outcomes of infants who received only abdominal compressions (AC-CPR).
This is a sub-group analysis of the prospective, observational cohort from the ICU-RESUS trial NCT028374497.
SETTING & PATIENTS: A single site quaternary care pediatric cardiothoracic intensive care unit enrolled in the ICU-RESUS trial. Patients less than 1 year of age with congenital heart disease who required compressions during cardiac arrest.
Use of AC-CPR during cardiac arrest resuscitation.
Invasive arterial line waveforms during CPR were analyzed for 11 patients (10 surgical cardiac and 1 medical cardiac). Median weight was 3.3 kg [IQR 3.0, 4.0]; and median duration of CPR was 5.0 [3.0, 20.0] minutes. Systolic (median 57 [IQR 48, 65] mmHg) and diastolic (median 32 [IQR 24, 43] mmHg) blood pressures were achieved with a median rate of 114 [IQR 100, 124] compressions per minute. Return of spontaneous circulation was obtained in 9 of 11 (82%) patients; 2 patients (18%) were cannulated for extracorporeal cardiopulmonary resuscitation (ECPR) and 6 (55%) survived to hospital discharge with favorable neurologic outcome.
AC-CPR may offer an alternative method to maintain perfusion for infants who experience cardiac arrest. This may have particular benefit in pediatric patients after cardiac surgery for whom external chest compressions may be harmful due to anatomic and physiologic considerations.
患有基础心脏病的患者在经历院内心脏骤停的儿科患者中占相当大的比例。在心脏手术后的儿科患者中，仅进行腹部按压的心肺复苏（AC-CPR）可能是标准胸外按压心肺复苏（S-CPR）的一种替代方法，具有额外的操作和生理优势。
定量描述心肺复苏（CPR）期间的血流动力学以及仅接受腹部按压（AC-CPR）的婴儿的结局。
这是对ICU-RESUS试验NCT028374497的前瞻性观察队列的亚组分析。
一家参与ICU-RESUS试验的单一地点四级护理儿科心胸重症监护病房。年龄小于1岁、患有先天性心脏病且在心脏骤停期间需要按压的患者。
在心脏骤停复苏期间使用AC-CPR。
对11名患者（10例心脏手术患者和1例内科心脏疾病患者）在CPR期间的有创动脉管路波形进行了分析。中位体重为3.3千克[四分位间距3.0，4.0]；CPR的中位持续时间为5.0[3.0，20.0]分钟。收缩压（中位值57[四分位间距48，65]mmHg）和舒张压（中位值32[四分位间距24，43]mmHg），每分钟按压中位速率为114[四分位间距100，124]次。11名患者中有9名（82%）恢复自主循环；2名患者（18%）接受了体外心肺复苏（ECPR）插管，6名（55%）存活至出院，神经功能结局良好。
AC-CPR可能为经历心脏骤停的婴儿提供一种维持灌注的替代方法。这对于心脏手术后的儿科患者可能特别有益，因为出于解剖学和生理学考虑，外部胸外按压可能有害。
