Posters

AP-086Pediatrics out of hospital cardiac arrest survival

J.M. Navalpotro Pascual, A.A. Mateos Rodrıguez

Emergency Medical Service of Madrid, SUMMA112, Spain

Introduction: To describe the epidemiology of paediatric out-of-hospital cardiac arrest in Madrid and survival to hospital arrival.

Methods: Retrospective observational study between January2002 and December 2003, of 582 CPR attempts.

Results: There were 18 paediatric cases (3.1% of total cardiacarrests). Six (33.3%) had ROSC on hospital arrival. 66.7% were male.76.5% had bradycardia or asystole and 23.5% VF/pulseless VT. Sur-vival was 75% for VF/pulseless VT and 23.1% for bradycardia orasystole. In 22.2% of case clinical staff were present and in 33.3%there were no witnesses. The survival when sanitary staff witnessedthe cardiac arrest was 50%, and for the group in which not-sanitarypersons were present were less than 25% and when there was nowitness was 33%. Survival if resuscitation started before the arrivalof the emergency unit was 38.5% compared with 0% if this did notoccur. Most cardiac arrests in our series were caused by trauma.

Conclusion: Out-of-hospital cardiac arrest is less common inchildren compared to adults. The overall survival rate is betterin children than adults. When CPR was not started before thearrival of the emergency services there were no survivors. If cardiacarrest occurred in the presence of the emergency service, survivalimproved. Survival was best in trauma patients.

doi:10.1016/j.resuscitation.2008.03.205

AP-087Radiological assessment of the paediatric chest: Need forrevising current guidelines for chest compression?

Pei-Chieh Kao, Wen-Chu Chiang, Chi-Wei Yang,Yueh-Ping Liu, Chien-Chang Lee, Chow-In Ko Patrick,Shyh-Jye Chen, Shyr-Chyr Chen, Matthew Huei-Ming Ma

Emergency Medicine, National Taiwan University Hospital, Taiwan

Introduction: The current guidelines on neonatal and paedi-atric resuscitation recommend a compression depth of 1/3 to 1/2of the anterior—posterior chest diameter (APD). However, therehas been little evidence supporting such manoeuvre. This studywas conducted to assess the actual depth of chest compressions inneonatal and paediatric populations if current guidelines are strictlyfollowed.

Methods: Chest computerised tomography (CT) of 12 neonatal(<1 year of age) and 11 paediatric (1—8 years of age) patients werereviewed. Measurements of AP diameter of chest CT scans (APD)were taken from the skin anteriorly perpendicularly to the skinon the posterior thorax at either the inter-nipple line (INL) or themiddle of the lower half of sternum (LS).

Results: In the neonatal group, there were 10 male infants withthe mean age was 0.39 years. In the paediatric group, there were7 male children with a mean age of 4.36 years. Our measurementsshowed that compression depth would be equal to or greater thanthe recommended depth for adult chest compression (3.8—5.1 cm)if current guidelines are followed. No difference in compressiondepth was found whether distance was measured at INL or LS (seeTable 1).

Table 1Location Neonatal (N = 12) Paediatric (N = 11)

INL LS INL LSAPD (cm) 10.2 ± 1.0 10.3 ± 1.2 13.2 ± 1.1 13.2 ± 1.11/3 APD (cm) 0.4 ± 0.3 3.4 ± 0.4 4.4 ± 0.4 4.4 ± 0.41/2 APD(cm) 5.1 ± 0.5 5.1 ± 0.6 6.6 ± 0.6 6.6 ± 0.6

odcltp

R

1

d

P

AAa

N

R

abto

2fipwoMw

o4rc3u4p(mwiw

otmw

R

1

2

S67

Conclusions: Measurements made from radiological assessmentsf the neonatal and paediatric chest indicate similar or higherepths of compression for neonatal and paediatric populations whenompared with the adult populations according to current guide-ines. More evidence is needed to provide a more realistic guideo the depth of chest compression in the neonatal and paediatricopulations.

eference

. 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emer-gency Cardiovascular Care Science with Treatment Recommendations. Part 3. Overviewof CPR. Circulation 2005;112(Suppl. I): IV—12.

oi:10.1016/j.resuscitation.2008.03.206

OST RESUSCITATION CARE

P-088n observational cohort study on outcomes of patientsdmitted to intensive care unit following cardiac arrest

. Davis-Gomez, T. Melody, L. Jiang, G.D. Perkins, F. Gao

Academic Department Anaesthesia, Critical Care and Painesearch, Birmingham Heartlands Hospital, UK

Introduction: Approximately 80% of survivors of cardiac arrestre comatose following return of spontaneous circulation and maye eligible for ICU admission. This study sought to establish long-erm outcomes (and predictors of outcome) in comatose survivorsf cardiac arrest admitted to ICU.

Methods: Adult patients, admitted to ICU between 1996 and004, who had CPR within 24 h prior to ICU admission, were identi-ed from the ICU database (ICNARC). Demographic and physiologicalarameters within 24 h of admission were collected. Organ failureas defined by SOFA score. Short-term (survival) and long-termutcomes (Karnofsky Performance Scores (KPS)) were recorded.ultiple logistic regression was used to identify factors associatedith poor outcome.

Results: 424 cardiac arrest survivors were admitted to ICU outf 5298 total admissions (8%). ICU and hospital survival rates was1% (n = 174) and 25% (n = 107), respectively, compared to survivalates of 73% and 64% in all patients (p < 0.001). Organ failure wasommon after admission (respiratory 54%; CVS 39%; renal 16%).5% had hyperglycaemia (BM > 11.1). Patients with ≥2 organ fail-re had a sixfold increase in hospital mortality (OR 6.8; 95% CI.4—10). APACHE 2, age; gender did not predict outcome. Mostatients discharged from hospital were alive at 1 (80%) and 2 years69%). The working age group (<65 years) comprised 18 patients,edian age 44.5 years (IQR 30—51). 1/3 were unable to return toork. Median KPS was 75. The non-working age group, (≥65 years)

ncluded 16 patients, median age 69 years (IQR 65—76). Median KPSas 95.

Discussion: Patients who develop multi-organ failure within 24 hf admission to ICU are at increased risk of death. Most patientshat survive to hospital discharge are alive at 1 year. There is highorbidity in young survivors and a third were unable to return toork.

eferences

. Peberdy MA, For the NRCPR Investigators. Cardiopulmonary resuscitation of adults in

the hospital: a report of 14,720 cardiac arrests from the National Registry of Cardiopul-monary Resuscitation. Resuscitation 2003;58:297—308.

. Vincent JL, Moreno R, Takala J, et al., On behalf of the Working Group on Sepsis-RelatedProblems of the European Society of Intensive care Medicine. The SOFA (Sepsis-relatedOrgan Failure Assessment) score to describe organ dysfunction/failure. Intensive CareMed 1996;22:707—10.

S Posters

d

ASe

N

G

itctipgeiwf

Ad5wfitfa

gnCni

amca

d

ATt

I

iaoTtrorr

t

pericardium. The circulatory system components included large tosmall arteries and veins as well as the capillary bed. Cardiac arrestwas simulated by stopping all active cardiac contraction and incor-porated changes in vascular resistance and compliance. Recoverywas simulated by starting active contractions dependent on theRV and LV cavity pressures and sizes and the degree of ischaemia(increased chamber stiffness and reduced contractility).Results:The simulation mimicked clinical results with a sharp then gradualfall in aortic pressure along with RV dilation. After 10 s of cardiacarrest the recovery of arterial blood pressure was rapid (<5 s). After1 min or more, the RV dilation and impingement on the LV cavityprolonged recovery to 20 s. For more prolonged arrests, recovery tonormal aortic pressure was delayed by simulated ischaemia for upto 2 min.

Discussion: The model simulates the main features of cardiacarrest physiology in detail. Recovery of aortic pressure after a car-diac arrest is more prolonged with longer duration of arrest, mainlydue to the effects of ischaemia but also, to a lesser extent, due toRV dilation.

doi:10.1016/j.resuscitation.2008.03.209

PROGNOSIS

AP-091Comparison between simultaneously recorded continuousencephalogram and standard encephalogram in post-cardiacarrest patients

A. Mathonnet, S. Rouhani, V. Lemiale, J. Charpentier,J.-D. Chiche, A. Cariou

Medical Intensive Care Unit, Cochin Hospital, Paris Descartes Uni-versity, Paris, France

Introduction: During post-anoxic coma, the value of standardelectroencephalogram (stEEG) is limited by its inability to provide acontinuous assessment. A continuous EEG (cEEG) monitoring system(S5TM Datex Ohmeda, Finland) is now available but its efficiency isnot established. We assessed the value and limitations of cEEG bycomparison with stEEG in post-cardiac arrest patients treated bymild hypothermia.

Methods: Over 6 months, all consecutive patients in post-cardiacarrest were studied. During the first 36 h, 1 cEEG and 3 stEEG perpatients were recorded. The cEEG was spliced into 3-h periods whichwere analyzed off-line by a neurophysiologist and two intensivistsblinded for stEEG results. Each analysis was classified as normalvoltage, low voltage, epileptic activity, burst suppression and flatEEG. Ability of the cEEG to predict stEEG patterns was evaluatedby assessing sensitivity, specificity, positive and negative predictivevalues (PPV and NPV). We also assessed the influence of hypother-mia, sedation and the inter-observer agreement (see Table 1).

Results: 23 patients were studied (mean age 57 ± 17 years) ofwhom 27% survived. 62 pairs of cEEG and stEEG were suitable foranalysis. The inter-observer agreement was 0.67.

The PPV and NPV of cEEG to predict the existence of a severeabnormal stEEG pattern (epileptic activity or burst suppression orflat EEG) were, respectively, 73% and 89% but improved in normoth-ermia and after sedation termination (PPV 88% and NPV 93%) (seeTable 1).

Table 1

68

3. Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: ameta-analysis of randomized controlled trials. Arch Intern Med 2004;164:2005—11.

4. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustardsin the palliative treatment of carcinoma. Cancer 1948;1:634—56.

oi:10.1016/j.resuscitation.2008.03.207

P-089evoflurane during cardiopulmonary resuscitation improvesarly post-resuscitation myocardial dysfunction in the rat

. Russi, P. Teschendorf, B. Boettiger, E. Popp

Department of Anesthesiology, University Hospital of Heidelberg,ermany

Introduction: Post-resuscitation myocardial dysfunction is anmportant cause of death in the intensive care unit after ini-ially successful cardiopulmonary resuscitation (CPR) of pre-hospitalardiac arrest (CA) patients. It is well known that volatile anaes-hetics reduce ischaemic—reperfusion injury in regional ischaemian beating hearts. This effect, called anaesthetic-induced pre- orost-conditioning, can be shown when the volatile anaesthetic isiven either before ischemia or in the reperfusion phase. How-ver, up to now, no data exist for volatile anaesthetics after globalschemia due to CA. Therefore, the goal of this study was to clarifyhether Sevoflurane improves post-resuscitation myocardial dys-

unction after CA in rat.Methods: Following institutional approval by the Governmental

nimal Care Committee, 29 male Wistar rats (350—400 g) were ran-omized either to receive Sevoflurane 2.5 vol.% (Sevo group) formin starting at the beginning of CPR, or to the control groupithout Sevoflurane. After 6 min of electrically induced ventricularbrillation, CPR was performed. Following restoration of spon-aneous circulation (ROSC), continuous measurement of ejectionraction (EF) and end-diastolic volume (EDV) was performed usingMillar catheter. All data are given as median (t-test; p < 0.05).

Results: During the first 3 h after ROSC, EF increased in the Sevoroup from 24% to 38%, while animals in the control group showedo increase at all (24%; Sevo vs. control, p < 0.01). EDV values beforeA were 258 �l (Sevo) and 220 �l (control), respectively. There waso significant change in EDV in the Sevo group (280 �l), whereas EDVncreased to 410 �l in the control group (p < 0.01).

Conclusions: In this animal model of CA and resuscitation,dministration of Sevoflurane improved two crucial parameters ofyocardial function. Increased EF and lowered EDV due to the appli-

ation of Sevoflurane might be a promising base for new therapeuticpproach after CA.

oi:10.1016/j.resuscitation.2008.03.208

P-090he rate of recovery of cardiac function after cardiac arrest: Aheoretical study

. Turner, S. Turner

Pacemaker Department, Papworth Hospital, UK

Introduction: During a cardiac arrest there is an initial rapid falln arterial pressure followed by a more gradual decline until arterialnd venous pressures equalize. This is accompanied by distensionf the right ventricle and compression of the left ventricular cavity.he aims of this study were to develop a mathematical model ofhe circulation to simulate a cardiac arrest and to investigate theelative importance of fluid shifts in the circulation and ischaemia

n the rate of recovery of blood pressure post-arrest. This rate ofecovery is important in determining duration of CPR required afterestoring normal rhythm.

Methods: The computer simulation model coupled right ven-ricle (RV), left ventricle (LV) and atria enclosed within the

Sensitivity Specificity PPV NPVNormal voltage (%) 100 94 80 100Low voltage (%) 63 88 81 75Epileptic activity (%) 50 80 8 98Burst suppression (%) 55 98 86 91Flat EEG (%) 60 100 100 93