Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes

Barreto, Jessica A.; Weiss, Noel S.; Nielsen, Katie R.; Farris, Reid; Roberts, Joan

doi:10.1016/j.resuscitation.2021.12.003

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…1 Although hypoxemia is generally thought to be harmful, there have been inconsistent differences in survival with hypoxemia, hyperoxemia, hypocapnia, and hypercapnia. [6][7][8] Hypotension is associated with lower survival after cardiac arrest, 9,10 but the survival effect of manipulating blood pressure after arrest remains unclear. 1 Finally, although hypoglycemia and hyperglycemia are associated with unfavorable outcomes in critically ill children, 11 no clinical trials have focused on the postarrest period.…”

Section: Introductionmentioning

confidence: 99%

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action

Barreto,

Wenger,

Dewan

et al. 2024

Pediatric Quality &Amp; Safety

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Background: Despite national pediatric postcardiac arrest care (PCAC) guidelines to improve neurological outcomes and survival, there are limited studies describing PCAC delivery in pediatric institutions. This study aimed to describe PCAC delivery in centers belonging to a resuscitation quality collaborative. Methods: An institutional review board-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution in the international Pediatric Resuscitation Quality Improvement Collaborative. Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data. Results: Twenty-four of 47 centers (51%) completed the survey. Most respondents (58%) belonged to large centers (>1,000 annual pediatric intensive care unit admissions). Sixty-seven percent of centers reported no specific process to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Common PCAC targets included temperature (96%), age-based blood pressure (88%), and glucose (75%). Most PCAC included electroencephalogram (75%), but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological examination (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities. Conclusions: There is wide variation in PCAC delivery among surveyed pediatric institutions despite national guidelines to standardize and implement PCAC.

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Section: Introductionmentioning

confidence: 99%

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action

Barreto,

Wenger,

Dewan

et al. 2024

Pediatric Quality &Amp; Safety

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“…Using 100% oxygen during CPR causes hyperoxia, which has been associated with increased mortality in newborn infants (21% O 2 during CPR associated with reduced relative risk 0.71 [95% CI 0.54 to 0.94], risk difference −0.05 [−0.08 to −0.01], and adults [odds ratio for death of 1.8 (95% CI, 1.5–2.2)] [ 6 , 7 ]. Studies assessing hyperoxia after cardiac arrest in pediatric patients reported no association with in-hospital mortality or poor neurological outcome [ 8 ]. Furthermore, hyperoxia leads to generation of oxygen free radicals, which have a role in reperfusion/reoxygenation injury after cardiac arrest [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets

Nyame

Cheung²,

Lee³

et al. 2022

Children

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Background: During pediatric cardiopulmonary resuscitation (CPR), resuscitation guidelines recommend 100% oxygen (O2); however, the most effective O2 concentration for infants unknown. Aim: We aimed to determine if 21% O2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC + SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100% O2 in infant piglets with asphyxia-induced cardiac arrest. Methods: Piglets (20–23 days of age, weighing 6.2–10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure < 25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC + SI or CCaV with either 21% or 100% O2 or the sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Main results: Baseline parameters, duration, and degree of asphyxiation were not different. Median (interquartile range) time to ROSC was 107 (90–440) and 140 (105–200) s with CC + SI 21% and 100% O2, and 600 (50–600) and 600 (95–600) s with CCaV 21% and 100% O2 (p = 0.27). Overall, six (86%) and six (86%) piglets with CC + SI 21% and 100% O2, and three (43%) and three (43%) piglets achieved ROSC with CCaV 21% and 100% O2 (p = 0.13). Conclusions: In infant piglets resuscitated with CC + SI, time to ROSC reduced and survival improved compared to CCaV. The use of 21% O2 had similar time to ROSC, short-term survival, and hemodynamic recovery compared to 100% oxygen. Clinical studies comparing 21% with 100% O2 during infant CPR are warranted.

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Post-resuscitation care in the NICU

Haggerty,

Bajaj,

Natarajan

et al. 2024

Seminars in Perinatology

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Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes

Cited by 4 publications

References 31 publications

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action

A Randomized, Controlled Animal Study: 21% or 100% Oxygen during Cardiopulmonary Resuscitation in Asphyxiated Infant Piglets

Post-resuscitation care in the NICU

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