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BackgroundOn the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, the American Heart Association recommends using blood pressure to guide pediatric CPR. However, evidence-based blood pressure targets during pediatric CPR remain an important knowledge gap for CPR guidelines.MethodsAll children ≥37 weeks' gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring before and during CPR between July 1, 2013, and June 31, 2016, were included. Mean DBP during CPR and Utstein-style standardized cardiac arrest data were collected. The hypothesis was that DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old would be associated with survival. Primary outcome was survival to hospital discharge. Secondary outcome was survival to hospital discharge with favorable neurological outcome, defined as Pediatric Cerebral Performance Categories 1 to 3 or no worse than prearrest baseline. Multivariable Poisson regression models with robust error estimates were used to estimate the relative risk of outcomes.ResultsBlinded investigators analyzed blood pressure waveforms during CPR from 164 children, including 60% <1 year old, 60% with congenital heart disease, and 54% after cardiac surgery. The immediate cause of arrest was hypotension in 67%, respiratory decompensation in 44%, and arrhythmia in 19%. Median duration of CPR was 8 minutes (quartiles, 3 and 27 minutes). Ninety percent survived the event, 68% with return of spontaneous circulation and 22% by extracorporeal life support. Forty-seven percent survived to hospital discharge, and 43% survived to discharge with favorable neurological outcome. Maintaining mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year old o

The current NATO Special Operations Forces (SOF) capability is an ad hoc force which does not provide a synchronized, integrated Special Operations response capability to the alliance. There is no standing NATO SOF combat force or Command and Control architecture to frame the transformation effort. NATO has declared its intentions to transform from a static collective alliance for the defense of the common members, to an expeditionary force capable of responding to the needs of a growing global security concern. The central research question is: Does NATO require a standing Special Operations Force command and control structure and combat capability to meet the emerging global security requirements of the Alliance? This research revealed that a more robust and interoperable SOF capability is both advocated and supported amongst member states. The comparison of recommended structure reforms produced consensus only in the function of improved SOF and not in the form of that innovation. Interviews with subject matter experts within the NATO SOF community revealed support for a standing command and control structure but not to a standing NATO SOF combat force. This research supports the current NATO SOF transformation initiative with the addition of growth to an inner core and wider network standing force.