16/11/2018, 09:29

3ª mejor comunicación de este Congreso Europeo de Urgencias

El Grupo Español de RCP Pediátrica y Neonatal, se encuentra de enhorabuena, en el  Congreso de la Sociedad Europea de Urgencias (EUSEM) celebrado el pasado mes de octubre 2015 en Turin, la comunicación presentada por la Coordinadora Autonómica, la Dra Nieves de Lucas titulada  “E-PEDCARE: first results of an international prospective registry of pediatric OHCA and EDCA” ha sido reconocida como la tercera mejor comunicación de este Congreso Europeo de Urgencias. Se trata de un estudio respaldado por el GERCPPYN, prospectivo, multicéntrico e internacional que registra información de las paradas cardíacas pediátricas prehospitalarias ingresadas en los servicios de Urgencias, y las sucedidas en los servicios de urgencia. Este gran estudio está permitiendo conocer los factores asociados a mejores resultados (supervivencia y resultados neurológicos) en la parada cardíaca pediátrica. 

Desde el GERCPYN deseamos felicitar a todos los participantes en este estudio y en especial a los autores de la comunicacion

 

Authors

• Nieves de Lucas (SAMUR-Protección Civil-Madrid, Ayuntamiento de Madrid – Madrid – SPAIN)

• Ignacio Manrique (Pediatría, Instituto Valenciano de Pediatría – Valencia – SPAIN)

• Antonio Rodríguez-Núñez (Cuidados Intensivos Pediátricos, Complejo Hospitalario de Santiago – A Coruña – SPAIN)

• Patrick Van de Voorde (Paediatric Intensive Care, University Hospital Ghent – Ghent – BELGIUM)

• Jesús López-Herce (Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón – Madrid – FRANCE)

• Jesús Payeras (Urgencias de Pediatría, Hospital Universitario Sant Joan de Déu – Barcelona – SPAIN)

• Sofía Mesa (Urgencias de Pediatría, Hospital Universitario 12 de Octubre – Madrid – SPAIN)

• Asunción Pino (Urgencias de Pediatría, Hospital Universitario Clínico de Valladolid – Valladolid – SPAIN)

• Carla Pinto (Urgencias de Pediatría, Hospital Pediátrico Coimbra – Coimbra – PORTUGAL)

• Nuria Clerigué (Urgencias de Pediatría, Complejo Hospitalario de Navarra – Pamplona – SPAIN)

• Zulema Lobato (Urgencias de Pediatría, Xarxa Assistencial Universitaria de Manresa – Manresa – SPAIN)

• Diana Moldovan (Emergency Department, Tirgu Mures Emergency Clinical County Hospital – Tirgu Mures – ROMANIA)

• Pediatric Cardiac Arrest Study Group (RISEUP, REPEM – GERCPPYN – SPAIN)

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Registry in Emergency Services

 (e-PEDCARE)

 

 

Participating Centers and countries

SPAIN:

− H. Alto Deba, Deba, Guipúzcoa

− H. Cabueñes, Gijón, Asturias

− H. Consorci Sanitari Terrassa, Barcelona

− H.U. de Basurto, Bizcaia

− H. Regional Universitario de Málaga

− H.U. del Tajo, Aranjuez, Madrid.

− H.U. La Paz

− H.U. Mutua Terrassa

− H.U. Príncipe de Asturias, Alcalá de Henares, Madrid

− H.U. Río Hortega

− H.U. Sant Joan de Deu, Barcelona

− Xarxa Assistencial Universitaria de Manresa, Barcelona

− H.U. Niño Jesús, Madrid

− H.U. Virgen de la Salud, Toledo

− H.U. Infanta Sofía, San Sebastián de los Reyes, Madrid.

− Complejo Universitario de Santiago, A Coruña

− H.U. Montepríncipe, Boadilla del Monte, Madrid

− H.U. Sanchinarro, Madrid

− H.U. Torrelodones, Madrid

− H.U. Barbastro, Huesca

− H.U. Virgen del Rocío, Sevilla

− H.U. Virgen de la Salud, Toledo

− H.U. 12 de Octubre, Madrid

− H. Santa Creu i Sant Pau, barcelona

− H.U. Gregorio Marañón, Madrid

− H. Zumárraga, Gipuzcoa

− H.U. Arcos del Mar Menor, Murcia

− H. Laredo, Sanander

− H. La Línea, Cadiz

− Complejo Hospitalario de Navarra

− H de Nens, Barcelona

− Idc H. Sur Alcorcón, Madrid

− H.U. Infanta Leonor, Madrid

− H.U. Infanta Cristina, Badajoz

− H. Xeral Vigo, Pontevedra

− Fundación Hospital de Calahorra, La Rioja

− H. San Pedro, Logroño, La Rioja

− H.U. Cuenca.

− H.U. General de Valencia

− H. Alcázar de San Juan, Ciudad Real

− H. Arnau de Vilanova, Lleida

− H.U. Puerta del mar, Cádiz

− H de la Ribera, Alzira, Valencia

− H. Parc Taulí, Sabadell, Barcelona

− H.U. Lugo

− H.U.Pontevedra

− H.U. Ferrol, A Coruña

− H.U. Doctor Peset, Valencia

− H.U. Clínico Valladolid

− H.Quirón Dexeus, Barcelona

− H.U. Marqués de Valdecilla, Santander

− H.U. Fundación Alcorcón, Madrid

− H. Clínico Universitario Virgen de la Arrixaca, Murcia

− H.U. Castellón

− H.U. Vall d'Hebron

− H.U. Salamanca

− H.U. de Canarias, Tenerife

− H.U.  Guadalajara

– SAMUR-Protección Civil, Madrid

 

PORTUGAL:

− H. Prof Dr Fernando Fonseca, Amadora

− H. García de Orta em Almada

− H. Pediátrico Coimbra

 

BELGIUM:

− University Hospital Ghent

 

ROMANIA

− Tirgu Mures Emergency Clinical County Hospital, Tirgu Mures

 

SLOVENJA

– University Medical Center Ljubljana, Ljubljana

 

THE NETHERLANDS

– ErasmusMC Rotterdam

FRANCE

– Centre Hospitalo-Universitaire de Pointe-à-Pitre/Abymes.

– H Nantes

Pending administrative issues:

– CHU de Rouen

– H. U. Raymond Poincaré, APHP, Garches

-H. Montepellier,

-H. Toulouse

 

 

Recruited patients

We have 71 recruited patients until 5 October, 2015.

Abstract to congresses

We have sent two abstracts to EUSEM 2015 in Torino, and two more to European Resuscitation Council 2015 in Praga, that are exposed:

E-PEDCARE: first results of an international prospective registry of pediatric Out-of-Hospital and Emergency Department Cardiac Arrest.

PURPOSE OF THE STUDY.Knowing the characteristics and outcomes of pediatric Out-of-Hospital and Emergency Department Cardiac Arrest (CA).

 

MATERIALS AND METHODS.  Prospective multicenter study (61 hospitals, 4 countries) of Out-of-Hospital CA (OHCA) and Emergency Department CA (EDCA). We used Utstein Style, focussing on epidemiology and variables associated with survival and neurological outcomes. We describe the preliminary results from 1st Jun 2014 to 15th May 2015. 

 

RESULTS. We have analysed 46 CA, 13% (6/46) EDCA. The median age was 6 years (interquartile range 1.7-10.9), 50% male. The CA happened  at home (39.1%), street (15.2%), school (4.3%), sports ground (2.2%) and other places (39.1%). Etiology: presumed cardiac (21.7%), trauma (17.4%), respiratory (17.4%), drowning/submersion (15.2%), other non-cardiac (15.2%) and unknown (13%). There was a bystander in 43.5%. However, “phone resuscitation” was started in only 17.4%. The most frequent initial rhythm was asystole (56.5% CA), followed by bradycardia (19.6%), ventricular fibrillation (VF, 8.7%), pulseless electrical activity (4.3%), pulseless ventricular tachycardia (2.2%) and unknown rhythm (8.7%). The most frequent known rhythm before return of spontaneous circulation (ROSC) was asystole (7/46, 15.2%) followed by VF (6/46, 13.0%).

  • Outcomes in 40 children with OHCA: ROSC in 29/40 (72.5%) and sustained ROSC in 24/40 (60%). Three children are still inpatients. Twelve have been discharged: 9/40 (22.5%) with paediatric overall performance category (POPC) 1, one with POPC 2, two with POPC 3.

  • Outcomes in 6 patients with EDCA: ROSC in 5 and sustained ROSC in 3, one of whom is still inpatient. Two children survived to discharge, one with POPC 3 and one with POPC 1.

 

CONCLUSIONS.  Our preliminary results of the E-PEDCARE registry demonstrate higher OHCA and EDCA survival (with acceptable to good neurological outcome) than previously reported. Continuous efforts are needed in order to know which variables are associated with better outcomes of CA in children.

Paediatric Out-of-Hospital-cardiac arrests and Emergency Department-cardiac arrests: factors associated with survival todischarge and improved neurological outcome.

PURPOSE OF THE STUDY.Knowing factors associated with survival to discharge and neurological outcome in Out-of-Hospital Cardiac Arrest (OHCA) and Emergency-Department Cardiac Arrest (EDCA).

MATERIALS AND METHODS.  Prospective study (61 hospitals, 4 countries) using Utstein style with paediatric OHCA and EDCA. Factors associated with survival and neurological outcome to discharge (paediatric overall performance category –POPC–) were analyzed from 1st Jun 2014 to 15th May 2015.

RESULTS. We have analyzed 46 paediatric cardiac arrests, 13% (6/46) EDCA, 4/46 unknown rhythm, 4/46 inpatients, 50% male. Median age of the sample: 6 years (interquartile range 1.7-10.9).

  • cleardotWe found association between survival to discharge and:

  • first rhythm different to asystole, p= 0.002. 12.5% (3/24) of patients whose first rhythm was asystole survived to discharge vs 66.7% with different known rhythm (8/12),

  • lower PELOD score in first 24 hours (p=0.04).

  • We found association between POPC≥ 4 to discharge and:

  • first rhythm different to asystole, p= 0.002. 87.5% (21/24) of patients whose first rhythm was asystole had POPC≥ 4 vs 33.3% with different known rhythm (4/12),

  • lower PELOD score in first 24 hours (p=0.035).

The survival rate to discharge in children whose first rhythm was PEA/bradycardia was higher than in children whose first rhythm was asystole, p=0.002. 2 children whose first rhythm was asystole survived to discharge, both with POPC=3.

CONCLUSIONS.  In our paediatric OHCA/EDCA study, patients whose first cardiac arrest-rhythm was different to asystole survived to discharge and had better neurological outcome (nevertheless some patients whose first rhythm was asystole survived to discharge with POPC=3). We need a larger tracing and to know more about other variables that may be associated with good outcome despite asystole as first rhythm. PELOD in first 24 hours seems to be a good predictor of survival and a good neurological outcome to discharge.

Some considerations


Since a) hospitals and patients recruitment is slow (some hospitals must resolve many internal administrative question before joining), b) cardiac arrest data are sent with some delay and c) data obtained provide new useful knowledge in a very serious condition, I propose to consider not closed the ending date of the study, committing in any case to present results on that date.