Safety events in pediatric out-of-hospital cardiac arrest

Hansen, Matthew; Eriksson, Carl; Skarica, Barbara; Meckler, Garth; Guíse, Jeanne Marie

doi:10.1016/j.ajem.2017.08.028

Cited by 20 publications

(27 citation statements)

References 24 publications

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“…Seven studies were in trauma patients (n = 500) [21,26,34,[39][40][41]44], six in arrested patients (n = 804) [5,17,25,29,33,38], and three in head injury patients (n = 414) [6,31,37], and the remaining studies comprised a mixed population of all patients requiring airway management (n = 9849). There was no association between team composition and type of paediatric patients treated (P = 0.875).…”

Section: Outcomes By Clinical Populationmentioning

confidence: 99%

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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Background: Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. Methods: We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Results: Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two (n = 3747) and 18 (n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67-76%) than non-physician teams with relaxants (95%, 95% CI 93-98%) and physician teams (99%, 95% CI 97-100%). Physician teams had higher first-pass success rate (91%, 95% CI 86-95%) than non-physicians with (75%, 95% CI 69-81%) and without (55%, 95% CI 48-63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3-22%) than non-physicians with (30%, 95% CI 23-38%) and without (39%, 95% CI 28-51%) relaxants. Conclusion: Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.

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Section: Outcomes By Clinical Populationmentioning

confidence: 99%

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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“…found, in eight simulated paediatric resuscitation scenarios, that four 10‐fold errors occurred. Hansen et al . performed a retrospective analysis of 35 paediatric out‐of‐hospital cardiac arrests, which found that 20% of patients were given a 10‐fold overdose of adrenaline.…”

Section: Need For Significant Dose Calculation and Manipulation Undermentioning

confidence: 99%

A systems‐centred approach to reducing medication error: Should pre‐hospital providers and emergency departments dose children by age during resuscitation?

Foster

Tagg

2019

J Paediatrics Child Health

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The high-risk, high-stress and high-stakes environment of out-of-hospital or emergency department paediatric resuscitation is prone to human error, and medication errors are common. This could be contributing to the difference in survival rate of resuscitation in the out-ofhospital versus inpatient setting. Medication for children during resuscitation requires estimation of the child's weight and calculation of the corresponding drug dose. Whilst both of these steps can lead to error, calculation errors (including 10-fold errors) are much more common and harmful than weight errors. Previous solutions aim to optimise each stage of the medication dosing process. Currently, Australian guidelines suggest using the highly inaccurate original advanced paediatric life support formula, weight = 2 × (age + 4), to dose medications in these settings. This means age is converted to weight, which is then converted to dose. There is no evidence that this is causing harm to patients. Therefore, it could be suggested that age could safely be converted straight to dose according to preset doses. This eliminates the need for any weight estimation or dose calculation, thus reducing the potential for error and harm.

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“…Resuscitation events are chaotic and stressful to many participants leading to multiple opportunities for errors. Errors during cardiac arrest management are common, with pediatric patients particularly susceptible due to the relative infrequency of pediatric cardiac arrests and wide-ranging patient weights and sizes necessitating more complex life support algorithms (defibrillation doses, medication doses, range of CPR quality goals) (43)(44)(45)(46)(47)(48). Clear evidence exists that the delivery of high quality chest compressions and rapid medication administration improves short-and longterm outcomes after cardiac arrest (49,50), however repeated studies show that the CPR delivered at the bedside does not meet guideline recommendations (51,52).…”

Section: Improving the Quality Of Cardiopulmonary Resuscitationmentioning

confidence: 99%

Making care better in the pediatric intensive care unit

Wolfe¹,

Mack²

2018

Transl Pediatr

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The relatively young field of pediatric critical care has seen a shift from an approach with little consideration for the complications and adverse effects resulting from the procedures and medications to a more cautious approach with careful concern for the associated risks. Many senior pediatric intensivists recall a time when nearly every patient had a central venous line and arterial line; and hospital acquired infections, pressure injuries, unplanned extubations, and venous thromboemboli were expected costs of aggressive care. In addition to the morbidity and mortality associated with many of the health care-acquired conditions (HACs) in children, the attributable cost due to these HACs contributes to the unsustainable health care financial crisis. The Centers for Medicare and Medicaid Services (CMS) often penalize hospitals for HACs, and also are beginning to reimburse in a bundled fashion such that complications become the institution's burden. In children, payors and patients' families are often saddling this burden of costs attributable to HACs. The direct attributable costs per event are staggering. Payors, families, patients, and health care teams now demand a circumspect approach to care: do no harm, but how?

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Safety events in pediatric out-of-hospital cardiac arrest

Abstract: Safety events were common during pediatric OHCA resuscitation especially in the domains of medications, airway/breathing, and arrest algorithms.

Cited by 20 publications

References 24 publications

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

A systems‐centred approach to reducing medication error: Should pre‐hospital providers and emergency departments dose children by age during resuscitation?

Making care better in the pediatric intensive care unit

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