Association Between Deviations From Cerebral Autoregulation-Derived Optimal Blood Pressure and Outcome After Pediatric Cardiac Arrest.

Background And Objectives: Cerebrovascular pressure autoregulation (CAR) maintains adequate cerebral blood flow (CBF) despite changes in cerebral perfusion pressure. CAR is disrupted after cardiac arrest, making the brain vulnerable to inadequate perfusion and oxygen delivery at population-derived guideline-recommended blood pressures. A metric of CAR can be used to determine the mean arterial pressure (MAP) at which CAR is most preserved, termed the optimal MAP (MAP).

Respiratory Targets Associated With Lung Aeration During Delivery Room Resuscitation of Preterm Neonates.

Importance: Effective lung aeration is crucial for successful postnatal transition. Goal targets to achieve lung aeration during positive pressure ventilation have not been established for preterm neonates.

Objective: To identify respiratory parameters associated with successful lung aeration during delivery room resuscitation.

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis.

Objectives: Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology.

Design: Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497).

Biologic Mechanisms Underlying the Heterogeneous Response to Tight Glycemic Control among Differentially Inflamed Patients in the HALF-PINT Trial.

Tight glycemic control (TGC) with insulin has not consistently shown benefit in critically ill patients. We previously reported that the subset of children with a hyperinflammatory subphenotype benefited from TGC in the HALF-PINT (Heart and Lung Failure - Pediatric Insulin Titration) study of hyperglycemic children with heart and lung failure and the IIT-SBPP (Intensive Insulin Treatment - Severely Burned Pediatric Patients) study in severely burned pediatric patients. However, whether this effect was mediated through a reduction in inflammation or some other biologic process is not fully understood.

Association of Early Epinephrine with Hemodynamics and Outcome in Pediatric In-Hospital Cardiac Arrest: A Secondary Analysis of a Multicenter, Cluster-randomized Clinical Trial Intensive Care Unit Resuscitation (ICU-RESUS).

Delayed (>5 minutes) epinephrine during pediatric in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Epinephrine is nearly always given earlier, limiting 5 minutes as a quality target. To assess early epinephrine administration (⩽2 minutes) on outcomes and hemodynamics during cardiopulmonary resuscitation (CPR) in pediatric IHCA from pulseless, nonshockable rhythms.

Risk Analytics Clinical Decision Support Decreases Duration of Vasoactive Infusions Following Pediatric Cardiac Surgery: A Multicenter Before and After Clinical Trial.

Objectives: Our primary objective was to quantify the effect of a clinical decision support system (CDSS) informed by inadequate delivery of oxygen index (ID o2 ), an algorithm that estimates the probability of inadequate oxygen delivery on inotropes and vasoactive infusions (IVAI) postoperatively.

Design: Multicenter before-and-after study conducted between June 01, 2020, and December 31, 2022.

Setting: Three pediatric cardiac ICUs (CICUs) at tertiary academic children's hospitals.

Resuscitation education science meets virtual and augmented reality: Evolution from potential concept to recommendations.

Aim Of The Study: This study aims to examine the evolution of recommendations for integrating Virtual Reality (VR) and Augmented Reality (AR) into adult Basic Life Support (BLS) education over time.

Data Sources: In December 2024, we conducted a two-phase search. First, we identified and reviewed publications available on the International Liaison Committee on Resuscitation (ILCOR) webpage, focusing on resuscitation education science, specifically addressing VR and/or AR in adult BLS education.

Analyzing resuscitation conference content through the lens of the chain of survival.

Background: Resuscitation science today often focuses on advanced topics such as extracorporeal cardiopulmonary resuscitation or targeted temperature management. However, the specific topics presented at resuscitation conferences have not been thoroughly analyzed. We thus analyzed resuscitation conferences abstracts using a chain of survival framework.

Extended reality technologies in adult basic life support education: A scoping review.

Aim: In recent years, virtual and augmented reality (VR/AR) technologies have gained increasing attention as innovative tools for education, including in the field of adult Basic Life Support (BLS). While existing reviews on this topic primarily focus on comparing VR/AR with other educational approaches, our research aimed to identify the VR/AR hardware and software applications assessed in published studies and their alignment with learning objectives in adult BLS education.

Methods: We conducted a scoping literature review using the Population, Exposure, and Outcome (PEO) framework to analyse publications from 2018 to 2024.

Environmental Sustainability in ICUs: A Report From the Society of Critical Care Medicine Sustainability Task Force.

Objectives: The charge of the newly formed Society of Critical Care Medicine Sustainability Task Force is to describe actionable items supporting environmental stewardship for ICUs, to discuss barriers associated with sustainability initiatives and outline opportunities for future impact.

Data Sources: Ovid Medline, EBSCOhost CINAHL, Elsevier Embase, and Scopus databases were searched through to March 2024 for studies reporting on environmental sustainability and critical care.

Study Selection: Systematic reviews, narrative reviews, quality improvement projects, randomized clinical trials, and observational studies were prioritized for review.

The Resuscitation, Equilibrium and De-escalation (RED) strategy: a phased, personalized hemodynamic support in children with sepsis.

Hemodynamic support in critically ill children with septic shock is a pervasive challenge in the intensive care settings. Cardiovascular involvement in sepsis entails both macro- and microcirculation abnormalities, with the main treatment objectives seeking to increase cardiac output and improve tissue perfusion, respectively. Fluid therapy and vasoactive drugs are cornerstone therapies for circulatory problems in sepsis.

Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure-Pediatric Insulin Titration (HALF-PINT) Trial.

Objectives: To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure-Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941).

Design: Non-prespecified post hoc analysis.

Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest.

Aims: To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained.

Methods: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497).

Results: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized.

Cardiopulmonary resuscitation employing only abdominal compressions in infants after cardiac surgery: A secondary sub-analysis of the ICU-RESUS study.

Importance: Patients with underlying cardiac disease form a considerable proportion of pediatric patients who experience in-hospital cardiac arrest. In pediatric patients after cardiac surgery, CPR with abdominal compressions alone (AC-CPR) may provide an alternative to standard chest compression CPR (S-CPR) with additional procedural and physiologic advantages.

Objective: Quantitatively describe hemodynamics during cardiopulmonary resuscitation (CPR) and outcomes of infants who received only abdominal compressions (AC-CPR).

Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients.

Background: Resuscitation with chest compressions and positive pressure ventilation in Bidirectional Glenn (BDG) or Fontan physiology may compromise passive venous return and accentuate neurologic injury. We hypothesized that arterial pressure and survival would be better in BDG than Fontan patients.

Methods: Secondary analyses of the Pediatric Intensive Care Quality of CPR and Improving Outcomes from Pediatric Cardiac Arrest databases.

Brief report: incidence and outcomes of pediatric tracheal intubation-associated cardiac arrests in the ICU-RESUS clinical trial.

Background: Tracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA.

Barriers and facilitators when seeking healthcare for septic children in Ghana: a single-centre qualitative study of patient caregivers and emergency department clinicians.

Background/purpose: Sepsis is a leading cause of morbidity, mortality and healthcare utilisation for children worldwide, particularly in resource-limited regions. In Kumasi, Ghana, organ system failure and mortality in children who present to the emergency department (ED) with symptoms of sepsis are often due to late presentation and lack of recognition and implementation of time-critical evidence-based interventions. The purpose of this study was to assess the barriers and facilitators for families in seeking healthcare for their septic children; and to understand the barriers and facilitators for ED providers in Kumasi to recognise and implement sepsis bundle interventions.

Evaluation of Automated Finger Compression for Capillary Refill Time Measurement in Pediatrics.

Objectives: Early shock reversal is crucial to improve patient outcomes. Capillary refill time (CRT) is clinically important to identify and monitor shock in children but has issues with inconsistency. To minimize inconsistency, we evaluated a CRT monitoring system using an automated compression device.

Association of EEG characteristics with outcomes following pediatric ICU cardiac arrest: A secondary analysis of the ICU-RESUScitation trial.

Background And Objectives: There are limited tools available following cardiac arrest to prognosticate neurologic outcomes. Prior retrospective and single center studies have demonstrated early EEG features are associated with neurologic outcome. This study aimed to evaluate the prognostic value of EEG for pediatric in-hospital cardiac arrest (IHCA) in a prospective, multicenter study.

Epinephrine Dosing Intervals Are Associated With Pediatric In-Hospital Cardiac Arrest Outcomes: A Multicenter Study.

Objectives: Data to support epinephrine dosing intervals during cardiopulmonary resuscitation (CPR) are conflicting. The objective of this study was to evaluate the association between epinephrine dosing intervals and outcomes. We hypothesized that dosing intervals less than 3 minutes would be associated with improved neurologic survival compared with greater than or equal to 3 minutes.

Association of Postarrest Hypotension Burden With Unfavorable Neurologic Outcome After Pediatric Cardiac Arrest.

Objective: Quantify hypotension burden using high-resolution continuous arterial blood pressure (ABP) data and determine its association with outcome after pediatric cardiac arrest.

Design: Retrospective observational study.

Setting: Academic PICU.