Pediatric cardiology
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Pediatric cardiology · Aug 2019
Randomized Controlled TrialDevelopment and Evaluation of a New Chest Compression Technique for Cardiopulmonary Resuscitation in Infants.
We designed the newly developed flexed two-finger chest compression technique for cardiopulmonary resuscitation (CPR) in infants to increase the quality of chest compression by considering the advantages and disadvantages of the two-thumb encircling hand technique and conventional two-finger technique. The aim of the study is to compare the performance of the flexed two-finger technique and the currently used two-thumb technique or two-finger technique for infant CPR. A total of 42 doctors conducted 2-min single-rescuer CPR on a cardiac arrest infant model using the two-thumb technique followed, in a random order, by the two-finger technique and the flexed two-finger technique. ⋯ The number of total chest compressions of the two-thumb technique was significantly lower than in the two-finger technique and flexed two-finger technique (150 [148-159] vs. 159 [149-173] vs. 162 [150-172], respectively, P < 0.001). The newly developed chest compression technique could provide adequate compression depth without increasing the hand-off time during single-rescuer infant CPR. Trial registration: Clinical Research Information Service, KCT0002730.
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Pediatric cardiology · Aug 2018
Randomized Controlled Trial Multicenter StudyDigoxin Use in Infants with Single Ventricle Physiology: Secondary Analysis of the Pediatric Heart Network Infant Single Ventricle Trial Public Use Dataset.
Digoxin has been associated with reduced interstage mortality after Norwood procedure. We sought to determine its association with survival and change in weight-for-age Z-score (WAZ) before the superior cavopulmonary connection (SCPC) surgery and at 14 months in a heterogeneous group of single ventricle infants. We performed a post-hoc analysis of the Pediatric Heart Network Infant Single Ventricle public use dataset to determine associations between digoxin and survival, transplant-free survival, and change in WAZ pre-SCPC and at 14 months. ⋯ Digoxin was associated with a greater decrease in WAZ from birth to pre-SCPC (- 1.96 ± 0.19 vs. - 1.31 ± 0.18, p < 0.001) and birth to 14 months (- 0.64 ± 0.15 vs. - 0.19 ± 0.15, p = 0.03). Digoxin was not associated with improved survival during the interstage or at 14 months in a mixed single ventricle cohort, but there was a trend towards improved interstage transplant-free survival in post-Norwood infants. As digoxin was associated with poorer weight gain, further research is needed to identify the risks/benefits for anatomic subtypes of infants with single ventricles.
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Pediatric cardiology · Aug 2015
Randomized Controlled TrialIn-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients.
Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to systemic inflammatory response syndrome (SIRS) with concomitant organ malfunction. Infused particles may exacerbate inflammatory syndromes since they activate the coagulation cascade and alter inflammatory response or microvascular perfusion. In a randomized, controlled, prospective trial, we have previously shown that particle-retentive in-line filtration prevented major complications in critically ill children. ⋯ Infused particles might aggravate a systemic hypercoagulability and inflammation with subsequent organ malfunction in pediatric cardiac intensive care patients. Particle-retentive in-line filtration might be effective in preventing SIRS and maintaining renal and hematologic function. In-line filtration offers a novel therapeutic option to decrease morbidity in cardiac intensive care.
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Pediatric cardiology · Oct 2014
Randomized Controlled TrialUltrasound- versus landmark-guided femoral catheterization in the pediatric catheterization laboratory: a randomized-controlled trial.
Ultrasound (US) is the standard of care for vascular access in many clinical scenarios. Limited data exist regarding the benefits of US- versus landmark (LM)-guided femoral vascular access in the pediatric catheterization laboratory. This study aimed to compare US- and LM-guided vascular access in the pediatric catheterization laboratory. ⋯ In this study, US access in the pediatric catheterization laboratory did not improve overall success. However, US improved accuracy and reduced the number attempts necessary for access without prolonging the access time of the procedure. Small children realized the greatest benefit of US-guided access.
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Pediatric cardiology · Feb 2013
Randomized Controlled Trial Comparative StudyJunctional ectopic tachycardia after congenital heart surgery in the current surgical era.
To determine the incidence of postoperative junctional ectopic tachycardia (JET) in a modern cohort of pediatric patients, evaluate possible risk factors for JET, and examine the effects of JET on postoperative morbidity and mortality. JET is common after congenital heart surgery. JET-related mortality has been a rare event at our center, which is different from previous reports. ⋯ JET remains a relatively common postoperative arrhythmia, but it is less frequent than previously reported. JET occurs more commonly in smaller patients with longer CPB runs and significant postoperative lactic acidosis levels. Mortality associated with JET is lower than historically reported, but morbidity remains high.