Should Sodium Bicarbonate Be Used In Pediatric Arrest?
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Administration of sodium bicarbonate during in-hospital pediatric cardiac arrest was associated with lower rates of survival to hospital discharge, return of spontaneous circulation, and survival with favorable neurologic outcomes and functional status.
Source
Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial. Pediatr Crit Care Med. 2022 Jul 26. doi: 10.1097/PCC.0000000000003045. Online ahead of print.
Calcium During a Code – It Can’t Hurt, Right?
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IV calcium administration during CPR for pediatric in-hospital cardiac arrest (IHCA) was associated with worse survival and should be restricted to specific indications, as recommended by the American Heart Association (AHA).
Source
Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease Is Associated With Worse Survival-A Report From the American Heart Association's Get With The Guidelines-Resuscitation (GTWT-R) Registry. Pediatr Crit Care Med. 2022 Jul 27. doi: 10.1097/PCC.0000000000003040. Online ahead of print.
How to Use POCUS for Pulse Checks – Is Manual Palpation Passé?
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Point-of-care ultrasound carotid artery compression was quicker than manual palpation in determining return of spontaneous circulation.
Source
Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation. Resuscitation. 2022 Jul 2;S0300-9572(22)00590-1. doi: 10.1016/j.resuscitation.2022.06.025. Online ahead of print.
CRITICAL – Indications for ECPR
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Registry study data finds the criteria to start extracorporeal cardiopulmonary resuscitation (ECPR) of age <75, time from emergency call to hospital arrival within 45 minutes and initial shockable rhythm to be predictive of good neurological outcomes and survival at one month.
Source
Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka. Resuscitation. 2022 Jun 14:S0300-9572(22)00568-8. doi: 10.1016/j.resuscitation.2022.06.007. Epub ahead of print.
Is Early ECPR Better than ACLS for OHCA?
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Early extracorporeal cardiopulmonary resuscitation was not superior to standard advanced cardiac life support for 180-day survival with good neurological outcome, but there may be a silver lining.
Source
Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2022 Feb 22;327(8):737-747. doi: 10.1001/jama.2022.1025.
Finger (or is that…probe) on the Pulse | Doppler vs Manual Palpation During Arrest
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Use of pulsed-wave Doppler ultrasound by a trained emergency medicine physician to detect any femoral pulse was more accurate than manual palpation but did not necessarily confer an adequate blood pressure (i.e. SBP ≥ 60 mmHg). Calculation of peak systolic velocity of ≥20 cm/s had a stronger correlation with a SBP ≥ 60 mmHg.
Source
Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation. 2022 Feb 4;S0300-9572(22)00032-6. doi: 10.1016/j.resuscitation.2022.01.030. Online ahead of print.
Battle of the Catecholamines – Epi vs Norepi for Post-Resuscitation Shock
Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine.
Source
Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022 Mar;48(3):300-310. doi: 10.1007/s00134-021-06608-7. Epub 2022 Feb 7.