{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Your Hand is Their Heart","description":"  Your Hand is Their Heart Brought to you by: Dr. Joelle Donofrio-Odmann and Dr. Joseph Finney     We are excited to be back with our second episode. In this episode, we tackle a really powerful topic in prehospital medicine, pediatric out of hospital cardiac arrest. Every paramedic will tell you that this is one of the toughest calls they\u2019ll ever go on. But it doesn't have to be. Join us as we will breakdown all the important steps necessary to give your patient the best chance of survival. Our guests are experts in prehospital medicine, resuscitation, and critical care. Together,  we will guide you through this anxiety provoking topic and ensure that you have all the tools you need to successfully manage the next pediatric out of hospital cardiac arrest. But we wont stop there! We will take you into the ICU for post-cardiac arrest care and even discuss what the future holds for out of hospital cardiac arrest.  You won't hear me say this often but when it comes to pediatric out of hospital cardiac arrest, it's time to start treating children like little adults. Website: https:\/\/sites.libsyn.com\/414020\/your-hand-is-their-heart Direct Download: https:\/\/traffic.libsyn.com\/34eda738-c0e3-471c-94e6-5d7bb718e70f\/Episode_2_FINAL-_POHCA.mp3   Content Experts: Paul Banerjee, Katherine Remick, Steve Laffey, Gina Pellerito, Matt Murray, Helen Harvey  B-side Narrator: Joseph Finney Editing and Publication: Phil Moy and Joseph Finney    Current Landscape of Pediatric Out of Hospital Cardiac Arrest:  5% bystander CPR (Atkins et al, 2009)  Overall, >5,000\/year (Atkins et al, 2009)  Survival (Atkins et al, 2009) Older children ~10%  Infant ~3%  Marked regional variation and associated with frequency of bystander CPR PEA\/Asystole is initial rhythm 80% of the time (Atkins et al, 2009) No improvement in survival in last decade (Jayaram et al 2015)  1 in 12 survive to hospital discharge (Jayaram et al 2015)  Resources The Pediatric Readiness Project https:\/\/emscimprovement.center\/domains\/pediatric-readiness-project\/readiness-toolkit\/   Check out this link for all the information your emergency department will need to ensure they are pediatric ready. We all need to make sure our hospital is ready for any patient and this means preparing for the next pediatric cardiac arrest.      American Heart Association https:\/\/www.heart.org\/?s_src=22U5W1AEMG&s_subsrc=evg_sem&gclid=Cj0KCQjwuO6WBhDLARIsAIdeyDIcTX32jP4p9AfuoAzx-GL5li7mtInhOxkeeopw1t-ahn4tqjG40acaAl0tEALw_wcB&gclsrc=aw.ds   Here you can find information for training and education to make sure your agency has the knowledge and skills to manage a pediatric patient in cardiac arrest. We strongly encourage every agency to maintain certification in PALS.    Literature Breakdown:   Early Epi is Key!! Andersen LW, Berg KM, Saindon BZ, Massaro JM, Raymond TT, Berg RA, Nadkarni VM, Donnino MW; American Heart Association Get With the Guidelines\u2013Resuscitation Investigators. Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest. JAMA. 2015 Aug 25;314(8):802-10. doi: 10.1001\/jama.2015.9678. PMID: 26305650; PMCID: PMC6191294.\u200b Data analysis of AHA sponsored database 2000-2014\u200b US pediatric patients (<18yo)\u200b In-hospital Cardiac arrest with initial non-shockable rhythm\u200b Primary outcome: Survival to discharge\u200b Secondary outcomes\u200b ROSC, 24h survival, and neuro status   Findings: Survival to discharge\u200b 487\/1558 (31.3%)\u200b ROSC\u200b 993\/1558 (63.7%)\u200b RR of 0.96 for every minute delay in EPI administration\u200b Favorable Neuro outcome (documented)\u200b 217\/1395 (15.6)\u200b RR of 0.94 for every minute delay in EPI administration\u200b \u200b Delay of epi >5min leads to decrease ROSC and decrease survival with favorable neurologic outcome   Thoughts:  Get the epi in right away!   Get on scene and get to work:    Banerjee PR, Ganti L, Pepe PE, Singh A, Roka A, Vittone RA. Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival. Resuscitation. 2019 Feb;135:162-167. doi: 10.1016\/j.resuscitation.2018.11.002. Epub 2018 Nov 6. PMID: 30412719.   This is a study of Polk County Fire and Rescue EMS database pre and post intervention. Polk County is a huge EMS agency in Florida with robust QI and data collection that has prompted several high profile publications. \u200b   In the study, the first group of data was collected between 2012-2013 when standard practice was for ALS interventions to occur enroute to ED and the second group was between 2014-2015 when there was a change for this agency to perform ALS interventions on scene after specialized training\u200b   There were 4  targeted Interventions instituted in 2014\u200b Rapid insertion of advanced airway (ETT or Igel)\u200b Immediate intra-osseous vascular access (deferring intravenous attempts)\u200b Early epinephrine\u200b Tight ventilation parameters (one breath every 10 seconds)\u200b   Study Details Primary outcome: Neuro intact survival\u200b 94 P-OHCA with median age 12mo\u200b 80% asystole initially \u200b Arrest etiology was 85% respiratory, 8% trauma, 3% seizures, 2% choking and no significant difference between groups\u200b \u200b They found that Neuro intact survival increased from 0% to 23.2% between the two groups\u200b     Time on Scene:  Tijssen, Janice A et al. \u201cTime on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest.\u201d Resuscitation vol. 94 (2015): 1-7. doi:10.1016\/j.resuscitation.2015.06.012  Observational study   ROC database 2005-2012   Age 3 days to 19 years   2244 patients   Study Aim: Identify which times on scene and which interventions were associated with improved survival  They found:  Time on scene of 10-35min had highest survival to hospital discharge (10.2%)  Adolescents had longest scene times and best outcomes  Infants had the shortest scene time, fewest interventions, and worst outcomes  Survival improved for all groups over the course of the study but the least for infants  Nuero outcome was unfortunately not reported    Other interesting findings:   IV\/IO access and fluid administration associated with improved survival (OR 2.4)  Advanced airway had no association with survival (OR 0.69)  Resuscitation meds (epi) associated with worse outcomes (OR 0.24)    ****Important to note, patients were included if ANY EMS resuscitation was undertaken even if they were subsequently discontinued****, this matters because scene time less than 10 min had poor outcomes and it's unclear if this is because the resuscitation was deemed futile and terminated. Further, scene time <10min had fewer witnessed events, shockable rhythms, attempts at advanced airway, IV\/IO attempts, and medications given compared to those with longer scene times.    ETT vs SGA (in OHCA)   Hansen ML, Lin A, Eriksson C, Daya M, McNally B, Fu R, Yanez D, Zive D, Newgard C; CARES surveillance group. A comparison of pediatric airway management techniques during out-of-hospital cardiac arrest using the CARES database. Resuscitation. 2017 Nov;120:51-56. doi: 10.1016\/j.resuscitation.2017.08.015. Epub 2017 Aug 22. PMID: 28838781; PMCID: PMC5660668.    3 year retrospective review of patients with non-traumatic OHCA <18yo using the CARES database  17 states, 55 cities  1724 OHCA  Odds ratio survival to discharge  ETI vs BVM 0.39 (95%CI 0.26-0.59)  SGA vs BVM 0.32 (95%CI 0.12-0.84)  ROSC  BVM 18% (n 781)  ETI 20% (n 727)  SGA 27% (n 215)  Survival to discharge  BVM 14% (n 781)  ETI 7% (n 727)  SGA 10% (n 215)  Good neuro outcome (CPC 1 or 2)  BVM 11% (n 781)  ETI 5% (n 727)  SGA 6% (n 215)  Conclusion: BVM is associated with higher survival to hospital discharge and increased neuro-intact survival compared to ETI and SGA. Special thank you to all our guests and content experts! Sources:\u200b Jayaram, Natalie et al. \u201cSurvival After Out-of-Hospital Cardiac Arrest in Children.\u201d Journal of the American Heart Association vol. 4,10 e002122. 8 Oct. 2015, doi:10.1161\/JAHA.115.002122\u200b Atkins, Dianne L et al. \u201cEpidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest.\u201d Circulation vol. 119,11 (2009): 1484-91. doi:10.1161\/CIRCULATIONAHA.108.80267\u200b\u200b\u200b\u200b\u200b\u200b\u200b Banerjee, Paul R et al. \u201cEarly On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival.\u201d Resuscitation vol. 135 (2019): 162-167. doi:10.1016\/j.resuscitation.2018.11.002\u200b\u200b\u200b Tijssen, Janice A et al. \u201cTime on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest.\u201d Resuscitation vol. 94 (2015): 1-7. doi:10.1016\/j.resuscitation.2015.06.012\u200b\u200b\u200b\u200b\u200b ","author_name":"The Pediatric EMS Podcast","author_url":"https:\/\/sites.libsyn.com\/414020","html":"