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BIBTEX RIS

4th World Congress on Emergency and Critical Care Medicine, Porto Alegre, Brazil, 5–8 March 2008

2009; Springer Nature; Volume: 1; Issue: 1 Linguagem: Inglês

10.1007/s13089-009-0004-9

2036-7902

James W. Tsung, Michael Blaivas, H Missaka, Myllena Cardoso Lima, Priscila Medina da Costa, Robson da Silva Almeida, S Divan Filho, A Arau, João José Aquino Machado, R Lannes, Débora Medeiros, WALTER PEREIRA NEVES FILHO, Carlos Clayton Macedo de Freitas, N Silva, R Mendonc,

Cardiac, Anesthesia and Surgical Outcomes

Background: Rapidly determining whether an unresponsive child is in cardiac arrest or in shock, and requiring cardiopulmonary resuscitation (CPR) can be problematic.The pulse check in children has been shown to be unreliable, not only for laypersons, but also for healthcare providers.The recommendation for checking the pulse in unresponsive children has been eliminated for laypersons in the latest edition of the Emergency Cardiovascular Care guidelines.Thus, the decision to initiate CPR in children, with the goal of delivering effective chest compressions, can be fraught with uncertainty.Outcomes for out-of-hospital pediatric cardiac arrest remain poor.The decision to end resuscitation in children, often an emotionally charged situation, can also be particularly difficult for physicians.Information from focused echocardiographic assessment in resuscitation (FEAR) examination that allows for correlation with the presence or absence of a pulse and real time assessment of resuscitation may help direct and optimize the delivery of resuscitative interventions.We report our preliminary clinical observations of using FEAR to correlate with the pulse check during resuscitation in a series of pediatric cardiac arrests.Methods: Observations were obtained from a non-consecutive case series of FEAR exams performed during pediatric cardiac arrest.Results: Between 1 January 2000 and 31 December 2006, 14 patients aged less than 19 years of age, experienced cardiac arrest on presentation to urban emergency departments or during their stay when the authors were on duty.Their clinical characteristics and echo observations are to be presented.We were able to visualize the heart in all patients using FEAR, and rapidly correlate cardiac activity with the presence or absence of a pulse without prolonged interruption of chest compressions.Two patients had return of spontaneous circulation and survived to hospital admission.Both of these patients survived to hospital discharge.Conclusions: It is feasible to use the FEAR exam to correlate with the pulse check during pediatric resuscitation.Furthermore, focused echocardiography may provide additional information in the decision to initiate or terminate CPR and may also lead to more relevant decision-making in pediatric cardiac arrest.