Recent discussions
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Ian Maconochie
Thank you - I note that the PICOST begins with Population: Adults and children with presumed cardiac arrest in any settings but that the literature search was based on adults: 'Evidence for adult and literature was sought and considered by the Basic Life Support Task Force. These data were taken into account when formulating the Treatment Recommendations.' I wondered about the recommendation which is based on the PICOST, ergo children would be included by default. -
Srabani Samanta
Effect of CPAP vs No CPAP in DR for late preterm and term infants with respiratory distress undergoing physiological umbilical cord clamping -
Kasper Lauridsen
Thank you for making this important review on chest compression pauses which is a difficult topic with a large heterogeneity. I appreciate the recommendation to minimize long pauses associated with defibrillation which is generally supported by the evidence and our general understanding of the pathophysiology of CPR. However, CCF is a complex metric as it covers both longer and shorter pauses. Overall, Cheskes 2015, Talikowska 2017, and Brouwer 2015 are in favor of lower CCF to improve survival outcomes. Cheskes 2011, Cheskes 2014, Wik 2005, Cheskes 2017, and Valenzuela 2005 show no difference for higher and lower CCF (Valenzuela 2005 although with a remarkable trend toward lower survival for higher CCF). Rea 2014 shows a benefit of higher CCF for prolonged resuscitation attempts only. Wik 2016 and Uppiretla 2019 favor higher CCF. Finally, Christenson 2009 favors CCF >20% and Vaillancourt 2011 favors CCF >40%. Based on this blurry picture with several studies favoring lower CCF, I am surprised to see a recommendation to keep CCF >60% as opposed to keeping the recommendation to avoid long CC pauses only. From the justification and evidence to decision framework highlights it is not clear why >60% was chosen as a cut-off (I have difficulties finding evidence to support this specific cut-off)? A few additional considerations: - For the knowledge gaps, I notice that the vast majority of studies are based on OHCA only and data on IHCA seem to be sparse? - Vadeboncoeur 2014 (doi: 10.1016/j.resuscitation.2013.10.002) shows better outcomes for lower CCF (NOTE: not included – was it excluded due to a good reason?). - Sell RE 2010 (doi:10.1016/j.resuscitation.2010.03.013) also finds that shorter pre- and post-shock pauses are associated with ROSC. Perhaps this study was not included due to a good reason? - For the justification section it may be considered to mention that other studies show that shorter pre-shock pauses are associated with successful defibrillation and termination of VF (supporting that we want to keep pauses short around defibrillations). - To me, it is difficult to make specific recommendations about CCF as a metric supported by: A) Studies trying to minimize short pauses for ventilation generally show no survival benefit (e.g. Nichol 2015), suggesting that a high CCF by avoiding short pauses is not beneficial (possibly also explaining the large heterogeneity in results?). B) Available studies on pediatric patients show no difference in CCF for survivors and non-survivors (http://dx.doi.org/10.1016/j.resuscitation.2015.04.010 & https://doi.org/10.1016/j.resuscitation.2018.07.015 ). C) Another study published after the last search was completed shows worse 30-day survival for higher CCF for IHCA (doi: 10.2147/OAEM.S341479). -
Srabani Samanta
Effect of tactile stimulation I’m conjunction with PPV for infants who continue to be apnoeic or have poor breathing effort after the first 60s of birth -
Shinichiro Ohshimo
Congratulations on the completion of the Systematic Review! I think this topic was very difficult to complete a systematic review on. My question is regarding the presence of an obstacle covering the head during sports (such as a helmet). I understand that this systematic review was intended for non-traumatic patients. If a patient wearing a helmet (e.g. American football, fencing, Kendo (Japanese fencing), etc.) suddenly collapses in the prone position and we are not sure if it is traumatic or non-traumatic, do you have any recommendations on whether we should remove the helmet by force or leave the helmet in place if we can check breathing and pulse? -
Dianne Atkins
Thank you for your comment. The three papers from the CARES network did not directly address the question we were asking. We contacted the CARES network, and they provided the numbers of pediatric patients with cardiac arrest, stratified by age as well as the numbers who had an AED applies and the outcome at hospital discharge. From these numbers, we calculated the relative risk of AED application. Thus, no patient was counted twice in the analysis. -
Dianne Atkins
thank you for your comment. I agree, that children absorb information rapidly and we often to do acknowledge all that they can do. I refer you to the work of Antonio Rodriguez-Nunez who has published on teaching very young children the initial steps of the chain of survival, recognition of a cardiac arrest, calling an emergency number and asking for assitance from those around them. -
Dianne Atkins
Thank you for commenting on our systematic review. Currently, there is very limited data on the use of the pediatric modifications when AEDs are used in children. In none of the papers that we reviewed, including those that did not meet all the inclusion or exclusion criteria, we found no information about dosage, pad size or algorithm accuracy. So, we were able to analyze the use of the devices without additional information. As to thepossible duplication of patients, the three papers from the CAREs registry did not directly address our question, although AED use was part of their analysis. We contacted the CARES registry and they provided for us the number of children who suffered a cardiac arrest in the same time period, stratified by age, the number who had an AED applied and the outcome at hospital discharge. From those numbers, we calculated the relative risk of survival if an AED was applied. There was no duplication of patient number. -
ARTHUR JACKSON
The study result seems to be slightly at odds with the referenced studies study, Why?? -
José Navarro-Vargas
excellent