Resuscitation
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Perinatal and neonatal deaths account for an increasing proportion of deaths under 5 years old. We present essential elements to reduce perinatal mortality, barriers to establishing these elements, and the role of developing emergency care systems. Essential elements for prompt perinatal and postnatal care are categorised based on care-seeking behaviours, access to a primary care facility and for the severely ill, access to advanced neonatal care. The role of emergency care systems is key to overcoming obstacles currently faced in countries with high perinatal and neonatal mortality rates.
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Randomized Controlled Trial
Therapeutic Hypothermia after Paediatric Cardiac Arrest: Pooled Randomized Controlled Trials.
Separate trials to evaluate therapeutic hypothermia after paediatric cardiac arrest for out-of-hospital and in-hospital settings reported no statistically significant differences in survival with favourable neurobehavioral outcome or safety compared to therapeutic normothermia. However, larger sample sizes might detect smaller clinical effects. Our aim was to pool data from identically conducted trials to approximately double the sample size of the individual trials yielding greater statistical power to compare outcomes. ⋯ Analysis of combined data from two paediatric cardiac arrest targeted temperature management trials including both in-hospital and out-of-hospital cases revealed that hypothermia, as compared with normothermia, did not confer a significant benefit in survival with favourable functional outcome at one year.
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Multicenter Study Observational Study
End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation.
Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating CPR performance to achieve end-tidal carbon dioxide (ETCO2) >20 mmHg. ⋯ Mean ETCO2 > 20 mmHg during pediatric in-hospital CPR was not associated with survival to hospital discharge, and ETCO2 was not different in survivors versus non-survivors.
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To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA). ⋯ An integrated program for rCA consisting of a formal pathway to uDCDD referral in ECPR ineligible patients is feasible. ECPR-referred patients had a reasonable survival with full neurologic recovery. Successful kidney transplantation was achieved with uDCDD.
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Comparative Study
Comparison of manual pulse palpation, cardiac ultrasonography and Doppler ultrasonography to check the pulse in cardiopulmonary arrest patients.
For health professionals, the absence of pulse checked by manual palpation is a primary indicator for initiating chest compressions in patients considered to have cardiopulmonary arrest (CA). However, using a pulse check to evaluate perfusion during CA may be associated with some risks of its own. Our objective was to compare the efficiency of cardiac ultrasonography (CUSG), Doppler ultrasonography (DUSG), and manual pulse palpation methods to check the pulse in CA patients. ⋯ The use of real-time CUSG during resuscitation provides a substantial contribution to the resuscitation team. CUSG will allow earlier and more accurate detection of pulse than manual pulse palpation and DUSG.