Search Results (51)

Introduction: Among aortic diseases in children, congenital defects such as coarctation of the aorta (CoA), interrupted aortic arch (IAA), hypoplastic aortic arch (HAA), and hypoplastic left heart syndrome (HLHS) predominate. Tissue patches are applied in pediatric cardiovascular surgery for the repair of congenital aortic defects as a filling material to replenish missing tissue or as a substitute material for the complete reconstruction of the vascular wall along the course of the vessel. This retrospective single-center study aimed to present the safety and feasibility of extracellular matrix (ECM) biological scaffolds in pediatric aortic surgery. Patients and methods: There were 26 patients (17 newborns and nine children), who underwent surgical procedures in the Department of Pediatric Cardiac Surgery (Poznań, Poland) between 2023 and 2024. The patients’ population was divided into two subgroups according to the hemodynamic nature of the primary diagnosis of the congenital heart defect and the performed pediatric cardiovascular surgery. The first group included 18 (72%) patients after aortic arch repair for interrupted aortic arch and/or hypoplastic aortic arch, while the second group included seven (28%) patients after aortopulmonary anastomosis. In the first group, patches were used to reconstruct the aortic arch by forming an artificial arch with three separate patches sewn together, primarily addressing the hypoplastic or interrupted segments. In the second group, patches were applied to augment the anastomosis site between the pulmonary trunk and the aortic arch, specifically at the connection points in procedures, such as the Damus–Kaye–Stansel or Norwood procedures. The analysis was based on data acquired from the national cardiac surgery registry. Results: The overall mortality in the presented group was 15%. All procedures were performed using median sternotomy with a cardiopulmonary bypass. The cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) median times were 144 (107–176) and 53 (33–79) min, respectively. There were two (8%) cases performed in deep hypothermic circulatory arrest (DHCA). The median postoperative stay in the intensive care unit (ICU) was 284 (208–542) h. The median mechanical ventilation time was 226 (103–344) h, including 31% requiring prolonged mechanical ventilation support. Postoperative acute kidney failure requiring hemodiafiltration (HDF) was noticed in 12% of cases. Follow-up data, collected via routine transthoracic echocardiography (TTE) and clinical assessments over a median of 418 (242.3–596.3) days, showed no evidence of patch-related complications such as restenosis, aneurysmal dilation, or calcification in surviving patients. One patient required reintervention on the same day due to a significantly narrow ascending aorta, unrelated to patch failure. No histological data from explanted patches were available, as no patches were removed during the study period. The median (Q1–Q3) hospitalization time was 21 (16–43) days. Conclusions: ProxiCor^® biological patches derived from the extracellular matrix can be safely used in pediatric patients with congenital aortic arch disease. Long-term follow-up is necessary to confirm the durability and growth potential of these patches, particularly regarding their resistance to calcification and dilation. Full article

Sudden unexpected death in epilepsy (SUDEP) is sudden, unexpected, witnessed or unwitnessed, nontraumatic, non-drowning death that occurs in a person with epilepsy. SUDEP is the leading cause of epilepsy-related death in adults with epilepsy, with an incidence of about 1.2 per 1000 person-years in the general epilepsy population. Recent studies have shown similar prevalence in the pediatric population too. Although the precise mechanism remains unclear, well-documented cases of SUDEP suggest that a generalized tonic clonic seizure-induced, centrally mediated change in cardiorespiratory function leads to terminal apnea and cardiac arrest. Risk factors include generalized tonic clonic seizure frequency, duration of epilepsy, nocturnal seizure, and certain genetic syndromes. Orexin, adenosine, and serotonin neurotransmission have been explored as novel drug targets to mitigate SUDEP risk. Neurostimulation and resective epilepsy surgery have been reported to have beneficial effects on long-term SUDEP risk as well. Future studies may aim to clarify the role of sleep and other comorbidities in SUDEP pathophysiology. Full article

Background: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. Methods: A retrospective analysis of 456 pediatric patients with IHCA (2018–2022) at the Children’s Hospital of Chongqing Medical University assessed demographics, arrest characteristics, outcomes and mortality risk factors. The primary outcome was survival to discharge; the secondary outcomes included return of spontaneous circulation (ROSC) > 20 min, 24 h survival, and favorable neurological outcomes. Logistic regression was used to identify the mortality risk factors. Results: ROSC > 20 min was achieved in 78.07% of cases, with 37.94% surviving to discharge (86.13% of survivors had favorable neurological outcomes). Etiological stratification identified general medical conditions (52.63%) as the predominant diagnoses, with surgical cardiac patients demonstrating superior resuscitation outcomes (ROSC > 20 min: 86.84%, discharge survival: 64.04%). Initial arrest rhythms predominantly featured non-shockable patterns, specifically bradycardia with poor perfusion (79.39%), whereas shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia) constituted only 4.17% of cases. Multivariable regression analysis identified five independent risk factors: vasoactive infusion before arrest (OR = 7.69), CPR > 35 min (OR = 13.92), emergency intubation (OR = 5.17), administration of >2 epinephrine doses (OR = 3.12), and rearrest (OR = 8.48). Notably, prolonged CPR (>35 min) correlated with higher mortality (8.96% survival vs. 48.54% for 1–15 min), yet all six survivors with CPR > 35 min had favorable neurological outcomes. Conclusions: These findings underscore the persistent challenges in pediatric IHCA management while challenging the conventional CPR duration thresholds for futility. The identified mortality risk factors inform resuscitation decision making and future studies. Full article

Background/Objectives: Pediatric cardiac arrest poses considerable obstacles, with survival rates markedly inferior to those of adults. Effective chest compressions are essential for enhancing outcomes; nevertheless, the ideal rescuer attitude is still ambiguous. This study sought to compare the efficacy of lateral (LAT) and over-the-head (OTH) chest compression techniques in pediatric cardiopulmonary resuscitation (CPR) and to ascertain whether OTH presents a viable alternative to the conventional LAT method by assessing compression quality, rescuer fatigue, and ergonomics. Methods: A randomized crossover simulation study was conducted in a high-fidelity medical simulation facility. Thirty-five medical students executed 2 min cycles of chest compressions with both LAT and OTH techniques, interspersed with a 15 min rest period between sessions. Results: OTH showed a tendency for enhanced overall performance (72.94 vs. 64.46; p = 0.08), while the differences lacked statistical significance. The compression rate was somewhat elevated with OTH (116.94 compared to 114.57; p = 0.31). We assessed LAT as somewhat less challenging (4.37 vs. 3.91; p = 0.17) and found less fatigue (4.83 vs. 4.40; p = 0.24). Male rescuers and individuals with elevated BMI attained larger compression depths. Age was negatively connected with the ease and efficiency of compressions. Conclusions: Although no statistically significant differences were detected, OTH demonstrated potential for enhanced performance. The anthropometrics of rescuers affected the quality of CPR, highlighting the necessity for tailored training methods. Future investigations should examine the long-term viability of OTH in clinical and pre-hospital environments. Full article

Background/Objectives: Cardiopulmonary resuscitation (CPR) in the prone position (P-CPR) is described in international guidelines for specific contexts but is not commonly included in operating room algorithms. This review aims to map P-CPR interventions in adult and pediatric patients experiencing cardiac arrest in the operating room while in the prone position. Methods: A scoping review was conducted following the “PRISMA Extension for Scoping Reviews” protocol. The databases searched included PubMed, CINAHL, ScienceDirect/Elsevier, Scopus, Web of Science, and Cochrane. Eligibility criteria included studies involving adult and pediatric populations, documented cardiac arrest (with presenting rhythm and cause), P-CPR interventions, and short-term outcomes (return of spontaneous circulation) as well as long-term outcomes when available. Results: Twenty international case reports were analyzed, indicating that P-CPR is effective in the operating room setting and has a positive impact on both short-term and long-term outcomes. Conclusions: This scoping review suggests that P-CPR yields comparable outcomes to supine CPR while saving time by eliminating the need for patient repositioning. However, due to limited evidence, further research is needed. Additionally, logistical, organizational, and educational considerations must be addressed before adopting P-CPR as routine practice. Full article

Background/Objectives: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is widely recognized as a critical intervention that significantly reduces no-flow time, improving survival rates in out-of-hospital cardiac arrests (OHCAs). This study evaluates current practices and the organization of DA-CPR in Italian emergency medical communication centers (EMCCs) and identifies areas for improvement. Methods: A cross-sectional survey was conducted between April and May 2024 among all Italian EMCCs, achieving a 92.6% response rate (62 out of 67) and covering 95.5% of the population. Data were collected on the availability of DA-CPR, additional medical instructions provided, standardized protocols, integration into dispatch software, availability of video call systems, and follow-up programs. Results: All responding EMCCs provide DA-CPR, with 79.1% (n = 49) initiating these protocols more than five years ago. In adult cardiac arrest, 74.2% (n = 46) provide instructions for chest compressions only. Standardized protocols are used in 69.4% (n = 43) of EMCCs, and 53.2% (n = 33) have these protocols integrated into their dispatch software. Additionally, 93.5% (n = 58) provide dispatcher-assisted instructions for other medical conditions, including pediatric CPR (90.3%, n = 56), neonatal CPR (90.3%, n = 56), foreign body airway obstruction (85.5%, n = 53), labor (56.5%, n = 35), and massive bleeding (41.9%, n = 26). A training path for DA-CPR is available in 48 EMCCs (77.4%), and in most cases, it is included in the basic dispatcher course (56.5%, n = 36), with 50% conducting periodic retraining. Moreover, 33.9% (n = 21) utilize video call systems to support dispatcher-assisted instructions. Data on DA-CPR are collected by 46.8% of EMCCs (n = 29), primarily on relevant cases, but only 25.8% (n = 16) have a follow-up path for patients. Conclusions: This study highlights a widespread implementation of DA-CPR across Italian EMCCs. However, regional disparities, mainly in protocols and technological support, indicate areas requiring urgent attention. Enhancing training programs and standardizing protocols could improve DA-CPR effectiveness and patient outcomes, thus guaranteeing equitable care nationwide. Future initiatives should focus on integrating support tools like video calls, expanding retraining programs, and establishing follow-up and debriefing paths. Full article

Background/Objectives: This study aimed to assess and compare the rates of medication error (ME) using the PediSTAT application compared to the conventional method of calculating the correct dose and determining the appropriate route of medication administration for common pediatric emergencies. Methods: A prospective cross-sectional study design was used for the study. Data were collected using a questionnaire that was distributed to certified paramedics holding a bachelor’s degrees or higher and working in Riyadh City, Saudi Arabia. Alternate simple random sampling was used to recruit the participants into two groups using the same questionnaire: the PediSTAT group and the conventional method group. The questionnaire contained four pediatric emergency vignettes: cardiac arrest, asthma exacerbation, seizures, and hypoglycemia. Results: A total of 63 participants agreed to the study. Almost 80% of them were males, 81% held bachelor’s degrees, and 87% were certified in pediatric resuscitation courses. The findings of the study showed that the use of the PediSTAT application increased accuracy and reduced the risk of ME for common pediatric emergencies. This was shown to be statistically significant for asthma medication dose (p-value < 0.001, 95% CI 0.034–0.352), midazolam dose (p-value = 0.012, 95% CI 0.030–0.764), and hypoglycemia medication dose (p-value < 0.001, 95% CI 0.046, 0.452). Conclusions: The study findings supported the use of standardized precalculated applications such as PediSTAT, which was shown to reduce the risk of ME in prehospital care for pediatric emergencies. Full article

Aim: Few studies have investigated the differential effects of targeted temperature management (TTM) according to the severity of the condition in pediatric patients with post-cardiac arrest syndrome (PCAS). This study was aimed at evaluating the differential effects of TTM in pediatric patients with PCAS according to a risk classification tool developed by us, the rCAST. Methods: We used data from a nationwide prospective registry for out-of-hospital cardiac arrest (OHCA) patients in Japan. We classified eligible pediatric PCAS patients (aged ≤ 18 years) into quintiles based on their rCAST scores and evaluated the effect of TTM on the neurological outcomes in each severity group. Then, focusing on the severity group that appeared to benefit from TTM, we also evaluated the effect of TTM by propensity score analysis. Good neurological outcome was defined as a score on the Cerebral Performance Category or Pediatric Cerebral Performance Category scale of ≤2 at 30 days. Results: Among 1526 OHCA pediatric patients enrolled in the registry, the data of 307 PCAS patients were analyzed. None of the patients in the fifth quintile (rCAST ≥ 18.5) showed a good neurological outcome, regardless of whether they received TTM or not (0% [0/20] vs. 0% [0/73]). The propensity score analysis showed that TTM was significantly associated with a good neurological outcome in patients with rCAST scores in the first to fourth quintile (odds ratio: 1.21 [1.04–1.40], p = 0.014). Conclusions: TTM was significantly associated with good neurological outcomes in pediatric PCAS patients with rCAST scores of ≤18.0. Full article

Background/Objectives: Multiple independent variables were analyzed to determine total nutritional intake (caloric and protein), while reviewing vasoactive inotrope scores (VISs). Methods: Retrospective data were collected for nutritional intake (N = 64), daily VISs, extracorporeal membrane oxygenation (ECMO) complications, delays in nutritional intake (>48 h), reason for delay, and interruptions in nutrition support. Results: VISs and ECMO characteristics analyzed by box–whisker plots demonstrated that ECMO complications prior to 24 h, cardiac arrest 24 h prior to ECMO, pediatric ECMO patients, venoarterial ECMO type, having a cardiac ECMO indication, and ECMO centrifugal pump had higher VISs. A regression analysis revealed that venovenous ECMO patients and the centrifugal pump type had higher caloric and protein intake; subsequently, for each increase in VIS, caloric intake decreased by −0.54. Sixteen patients did not receive nutritional support while on ECMO (9/16; 56% cardiac); 12/48 (25%) had a delay, with the cardiac patients nearing statistical significance. Conclusion: Venovenous ECMO (non-cardiac) correlated with higher nutritional intake. The enteral administration of nutrition had a lower VIS on average compared to the other three groupings, namely enteral vs. parenteral; enteral vs. both enteral and parenteral; enteral vs. no nutrition. This study provides additional clinical insight on nutritional intake in ECMO patients. Full article

Background and Objectives: We aimed to assess the outcomes of pediatric in-hospital cardiac arrests (IHCAs) and to identify key factors influencing survival. Materials and Methods: This retrospective, single-center study examined the demographic characteristics, symptoms, comorbidities, initial rhythm, duration of cardiopulmonary resuscitation (CPR), lactate levels, and outcomes of pediatric patients with IHCAs and compared these parameters between survivors and non-survivors. Results: A total of 43 patients were included in this study, including 21 boys (48.8%) and 22 girls (51.2%) with a median age of 36 months (range 1–203). CPR was initiated due to pulselessness in 23 patients (53.5%), respiratory arrest in 13 (30.2%), and bradycardia in 7 (16.3%). The first monitored rhythm in the emergency department was asystole in 29 patients (67.4%) and bradycardia in 14 (32.6%). Despite effective CPR, the mortality rate was 65.1% (n = 28). As a prognostic factor, asystole was found to be more common in non-survivors than in survivors (83.1% vs. 40%, p = 0.005). Additionally, lactate levels (16.6 vs. 10.6, p = 0.04) and CPR duration (45 vs. 15 min, p < 0.001) were significantly higher in non-survivors. Conclusions: IHCAs remain a critical concern, with varying outcomes influenced by factors such as initial rhythm, lactate levels, and CPR duration. Full article

Background. Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. Methods. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. Results. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Conclusions. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases. Full article

Children in prehospital emergency care are particularly vulnerable to medication errors, often with serious consequences. A prior study analyzing prehospital pediatric medication dosing errors, conducted after the implementation of a statewide pediatric drug-dosing reference for emergency medical services (EMS), identified an alarmingly high error rate. This significant finding led to the current study, which aims to develop technological interventions to reduce the frequency of medication errors for children during treatment by EMS. The current study focuses on the design and development of a safety strategy to automate medication administration using mixed-reality technology. Simulations were conducted to inform the design process, focusing on three scenarios: cardiac arrest, seizure, and burns. The design team included medical and engineering researchers, paramedics, and emergency medical technicians from multiple emergency medical service agencies. Root cause analysis (RCA) and failure mode and effects analysis (FMEA) were conducted after the simulations were completed. The RCA and FMEA were used to identify and prioritize failure points, which were then addressed in a mixed-reality solution using Microsoft HoloLens 2 to automate and enhance pediatric medication administration in prehospital emergency care. The resulting application will provide real-time assistance to guide paramedics through the complicated medication dosing and administration process using a detailed step-by-step guide, aiming to decrease medication errors and improve medication dosing accuracy. Full article

Introduction: Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency–urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools. Our analysis aims to analyze Out-of-Hospital Cardiac Arrest (OHCA) events in pediatric patients (under 18 years old), to understand the epidemiology of this phenomenon and provide helpful evidence for policy-making. Methods: A retrospective observational analysis was conducted on the emergency databases of Lombardy Region, considering all pediatric OHCAs managed between 1 January 2016, and 31 December 2019. The demographics of the patients and the logistics of the events were statistically analyzed. Results: The incidence in pediatric subjects is 4.5 (95% CI 3.6–5.6) per 100,000 of the population. School buildings and sports facilities have relatively few events (1.9% and 4.4%, respectively), while 39.4% of OHCAs are preventable, being due to violent accidents or trauma, mainly occurring on the streets (23.2%). Conclusions: Limiting violent events is necessary to reduce OHCA mortality in children. Raising awareness and giving practical training to citizens is a priority in general but specifically in schools. Full article

Pertussis continues to be a highly contagious respiratory infection, especially in children, with cyclical peaks of disease spread every three to five years. Here, we report relevant cases of B. pertussis infection between August 2023 and January 2024, and compare them with B. pertussis prevalence in pediatric patients admitted to the Reference Italian Pediatric Hospital, located in Rome, from January 2015 to July 2023. A total of 5464 tests for B. pertussis were performed during the study period, and 6.9% were positive. At the time of the COVID-19 pandemic, there was a sharp decrease in the presence of B. pertussis, which reappeared only in August 2023, recording five new cases. All five children presented with paroxysmal cough 5 to 10 days before admission. Four patients had other mild respiratory symptoms and moderate B. pertussis DNA levels (Ct mean: 26). Only one child, with very high B. pertussis DNA levels (Ct: 9), presented with severe respiratory failure. The patients with mild/moderate infection achieved clinical recovery while the patient with the severe manifestation died of cardiac arrest. These observations highlight the reemergence of pertussis even in vaccinated countries and its association with morbidity and mortality especially in young children. This emphasizes the importance of rapid diagnosis to immediately implement appropriate treatment and monitoring of immune status. Full article

Out-of-hospital cardiac arrest (OHCA) is heterogeneous in terms of etiology and severity. Owing to this heterogeneity, differences in outcome and treatment efficacy have been reported from case to case; however, few reviews have focused on the heterogeneity of OHCA. We conducted a literature review to identify differences in the prognosis and treatment efficacy in terms of CA-related waveforms (shockable or non-shockable), age (adult or pediatric), and post-CA syndrome severity and to determine the preferred treatment for patients with OHCA to improve outcomes. Full article