Search

Author(s): Jerry P. Nolan [sup.1] [sup.2] , Alain Cariou [sup.3] Author Affiliations: (1) grid.5337.2, 0000000419367603, University of Bristol, , Bristol, UK (2) grid.416091.b, 0000000404170728, Royal United Hospital, , Bath, UK [...]

Byline: T. Horisberger (1), J. Fischer (1), S. Fanconi (2) Keywords: Cardiopulmonary resuscitation Children Infants Outcome Prediction Abstract: Objective: Reported survival after cardiopulmonary resuscitation (CPR) in children varies considerably. We aimed to identify predictors of 1-year survival and to assess long-term neurological status after in- or outpatient CPR. Design: Retrospective review of the medical records and prospective follow-up of CPR survivors. Setting: Tertiary care pediatric university hospital. Patients and m ethods: During a 30-month period, 89 in- and outpatients received advanced CPR. Survivors of CPR were prospectively followed-up for 1 year. Neurological outcome was assessed by the Pediatric Cerebral Performance Category scale (PCPC). Variables predicting 1-year survival were identified by multivariable logistic regression analysis. Interventions: None. Results: Seventy-one of the 89 patients were successfully resuscitated. During subsequent hospitalization do-not-resuscitate orders were issued in 25 patients. At 1 year, 48 (54%) were alive, including two of the 25 patients with out-of-hospital CPR. All patients died, who required CPR after trauma or near drowning, when CPR began >10 min after arrest or with CPR duration >60 min. Prolonged CPR (21--60 min) was compatible with survival (five of 19). At 1 year, 77% of the survivors had the same PCPC score as prior to CPR. Predictors of survival were location of resuscitation, CPR during peri- or postoperative care, and duration of resuscitation. A clinical score (0--15 points) based on these three items yielded an area under the ROC of 0.93. Conclusions: Independent determinants of long-term survival of pediatric resuscitation are location of arrest, underlying cause, and duration of CPR. Long-term survivors have little or no change in neurological status. Author Affiliation: (1) Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland (2) Department of Pediatrics, CHUV, Lausanne, Switzerland Article History: Received Date: 20/04/2001 Accepted Date: 05/11/2001 Article note: Electronic Publication

Byline: S. Gando (1), S. Nanzaki (1), Y. Morimoto (1), S. Kobayashi (1), O. Kemmotsu (1) Keywords: Key words Cardiac arrest; Cardiopulmonary resuscitation; Soluble adhesion molecules; Neutrophil; Endothelium Abstract: Objectives: To investigate the inflammatory responses in patients with out-of-hospital cardiac arrest, we examined the changes in markers of endothelial activation, neutrophil activation, and endothelial injury.APDesign: Prospective, cohort study.APSetting: General intensive care unit of a tertiary care center.APPatients and participants: Forty-four out-of-hospital cardiac arrest patients were classified into two groups, those who achieved return of spontaneous circulation (ROSC) (n = 23) and those without ROSC (n = 21). Eight normal healthy volunteers served as control subjects.APMeasurements and results: Serial levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin) as markers of endothelial activation, neutrophil elastase as a marker of neutrophil activation, and soluble thrombomodulin as a marker of endothelial injury were measured during and after cardiopulmonary resuscitation (CPR). In patients with ROSC, cardiac arrest and CPR led to increases in the levels of three vascular endothelial adhesion molecules, neutrophil elastase, and soluble thrombomodulin that peaked 6 h or 24 h after arrival at the emergency department. In patients without ROSC, only neutrophil elastase showed moderate elevation during CPR. We could not find significant differences in all measured parameters between the two groups.APConclusions: As evidence of inflammatory responses in whole-body ischemia and reperfusion, our study demonstrates neutrophil-endothelium interaction with signs of endothelial injury in patients with out-of-hospital cardiac arrest. These inflammatory changes may have an important role in post-resuscitation syndrome after human cardiac arrest. Author Affiliation: (1) Department of Anesthesiology and Intensive Care, Hokkaido University School of Medicine, N15 W7, Kita-ku, Sapporo, 060 Japan e-mail: sgando@med.hokudai.ac.jp Tel.: + 81-11-7 06 73 77 Fax: + 81-11-7 06 73 78, JP Article note: Received: 19 May 1999 Final revision received: 9 November 1999 Accepted: 15 November 1999

Author(s): Humberto Correa [sup.1] Author Affiliations: (1) Instituto Universitario CLAEH, , Punta del Este, Montevideo, Uruguay It was a beautiful late summer day. The serenity of the morning and a [...]