Science Current Events | Science News | Brightsurf.com
 

When a child's heart stops, onset time of abnormal rhythms is crucial

June 01, 2006
Largest study of in-hospital cardiac arrest in children overturns conventional medical wisdom

Ventricular fibrillation, the life-threatening disordered heart rhythms that may accompany full cardiac arrest, occurs more frequently in children than commonly believed, according to a large national pediatric study.

Furthermore, not all ventricular fibrillation (VF) is the same, said study co-investigators Vinay Nadkarni, M.D., and Peter A. Meaney, M.D., M.P.H., specialists in Critical Care Medicine at The Children's Hospital of Philadelphia. They added that VF is more likely to be fatal if it is not the initial heart rhythm detected at the start of cardiac arrest, but instead develops later during the arrest, typically during resuscitation.

A research team from the American Heart Association's National Registry of Cardiopulmonary Resuscitation (CPR) analyzed records from more than 1,000 children who suffered cardiac arrests while in the hospital. The largest study by far of outcomes from VF in children, it appears in the June 1 issue of the New England Journal of Medicine. Researchers from Children's Hospital and from the University of Arizona led the study, which included records from 159 participating hospitals.

"This landmark in-hospital study challenges prevailing paradigms in pediatric cardiac critical care," said senior author Robert A. Berg, M.D., of the Steele Children's Research Center at the University of Arizona. "Abnormal rhythms were thought to be uncommon during cardiac arrests in children, occurring less than 10 percent of the time, but we found the occurrence to be 27 percent. When physicians applied shocks promptly from defibrillators, many of these children survived, and the vast majority of the survivors have good neurological outcomes."

"Secondly," continued Dr. Berg, "we learned that cardiac arrests due to initial shockable rhythms often have good outcomes, whereas cardiac arrests with shockable rhythms developing during resuscitation typically have poor outcomes. Now we have to learn what we can do to improve outcomes from the latter cases."

Of the 1,005 children who suffered in-hospital cardiac arrest, more than one in four (272 patients) had documented VF or tachycardia (rapid heart beats) that require shocks at some point during the arrest. In 104 of those patients VF or tachycardia occurred initially, while in 149 patients it occurred at a subsequent time during the arrest. Of the children with initial abnormal rhythms, 35 percent survived to hospital discharge, compared to 11 percent of children with subsequent abnormal rhythms.

The largest group of patients with cardiac arrest, 733 children, had no documented VF or tachycardia. A majority of the group, 602 patients, was known to have asystole (no heart contractions) or no pulse at the start of cardiac arrest. This group had intermediate outcomes: 27 percent survived to hospital discharge.

The researchers were surprised that this group with no VF had better outcomes than children with subsequent VF. Unlike patients with VF, shock delivery with defibrillators does not help patients with asystole or pulseless rhythms.

The question of why survival outcomes from subsequent VF were so low is interesting and requires more research, according to the researchers. One possible explanation, said Dr. Berg, is that children with subsequent VF have more severe underlying heart disease. Another possibility is that clinicians are less aware of the possibility of subsequent VF, and may not diagnose and treat it until it is recognized very late in resuscitation efforts. If this is the case, he added, better recognition, diagnosis and treatment of subsequent VF might improve survival.

The authors point out that, although outcomes may vary, the majority of children with cardiac arrest do not survive to hospital discharge. However, they stress that "CPR and advanced life support are certainly not futile," even among the group with the worst outcomes — children with subsequent VF and tachycardia.

Based partly on data reported by the National Registry of CPR, the American Heart Association recently issued new guidelines for CPR and emergency cardiovascular care, both for children and adults. "Our findings reinforce the concept that CPR with early recognition of shockable rhythms remains a most important aspect of successful cardiac resuscitation," added Dr. Nadkarni, "but clearly, we need to continue to develop, teach and implement better strategies using registries and networks that help us to discern key aspects of cardiac arrest."

Children's Hospital of Philadelphia


Related Cardiac Arrest Current Events and Cardiac Arrest News Articles


Selenide protects heart muscle in the wake of cardiac arrest
Damage to heart muscle from insufficient blood supply during cardiac arrest and reperfusion injury after blood flow is restored can be reduced by nearly 90 percent if selenide, a form of the essential nutrient selenium, is administered intravenously in the wake of the attack.

Physically active middle-aged adults have low risk of sudden cardiac arrest
Sudden cardiac arrest during sports activities is relatively low among physically active middle-aged adults, according to research in the American Heart Association journal Circulation.

Neurologic function, temperature management in patients after cardiac arrest
Quality of life was good and cognitive function was similar in patients with cardiac arrest who received targeted body-temperature management as a neuroprotective measure in intensive care units in Europe and Australia, according to an article published online by JAMA Neurology.

Middle-aged athletes at low risk for sudden cardiac arrest while exercising
Middle-aged athletes are at low risk for having a sudden cardiac arrest while playing sports, and those who do have a greater chance of surviving the usually-fatal condition, shows a new Cedars-Sinai Heart Institute study.

Study: Near-death brain signaling accelerates demise of the heart
What happens in the moments just before death is widely believed to be a slowdown of the body's systems as the heart stops beating and blood flow ends.

Drowned children do not benefit from resuscitation beyond 30 minutes
Children who drown and suffer from cardiac arrest with hypothermia are significantly more likely to die or suffer severe brain damage if resuscitation continues for more than 30 minutes, finds a study published in The BMJ.

Simple blood test can predict risk of dementia
Scientists at Rigshopitalet, Herlev Hospital and the University of Copenhagen identify a new biomarker that can predict the risk of developing dementia by way of a simple blood test. In the long term, this could mean better prevention and thus at least postponement of the illness and at best evading the development all together.

Peptide shows promise in penetrating heart attack scar tissue to regenerate cardiac nerves
Case Western Reserve's chemical compound aimed at restoring spinal cord function may have an additional purpose: stopping potentially fatal arrhythmias after heart attack.

Hydrogen sulfide could help lower blood pressure
A gas that gives rotten eggs their distinctive odour could one day form the basis of new cardiovascular therapies.

New hope for understanding sudden cardiac arrest
New biosciences research at the University of Kent could point the way to greater understanding of the heart mutations that cause sudden cardiac arrest.
More Cardiac Arrest Current Events and Cardiac Arrest News Articles

Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd Edition

Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd Edition
by Norman A. Paradis (Editor), Henry R. Halperin (Editor), Karl B. Kern (Editor), Volker Wenzel (Editor), Douglas A. Chamberlain (Editor)


Cardiac Arrest is the definitive and most comprehensive reference volume in advanced life support and resuscitation medicine. This new edition brings the reader completely up-to-date with developments in the field, focusing on practical issues of decision making, clinical management and prevention, as well as providing explanations of the science informing the practice. This volume is essential reading for all those involved in the emergency care of cardiac patients, either in the pre-hospital or hospital setting.

Cardiac Arrest

Cardiac Arrest


Ella Marley's world is shattered when a botched robbery costs her beloved older brother his life. She must try to move on while enduring a murder investigation that twists her emotions.
Detective Cory McCray couldn't help but be drawn to her the first time he set eyes on her in the hospital. He struggles to keep his feelings in check - he has a case to solve. But as the pieces come together, he wonders where she fits in - and if he is thinking with his head or his heart.
Cardiac Arrest is a quick, romantic read with a touch of mystery.

Coronary Artery Disease, Cardiac Arrest and Bypass Surgery: Risk Factors, Health Effects and Outcomes (Cardiology Research and Clinical Developments)

Coronary Artery Disease, Cardiac Arrest and Bypass Surgery: Risk Factors, Health Effects and Outcomes (Cardiology Research and Clinical Developments)
by Atsuko Sato (Editor), Seiji Hayashi (Editor)


Book annotation not available for this title.
Title: Coronary Artery Disease, Cardiac Arrest and Bypass Surgery
Author: Sato, Atsuko (EDT)/ Hayashi, Seiji (EDT)
Publisher: Nova Science Pub Inc
Publication Date: 2012/06/30
Number of Pages: 292
Binding Type: HARDCOVER
Library of Congress: 2011040277

ECG Handbook of Contemporary Challenges

ECG Handbook of Contemporary Challenges
by Mohammad Shenasa (Author), Mark E. Josephson (Author), N. A. Mark Estes (Author), Mohammad Shenasa (Editor), Mark E. Josephson (Editor), N.A. Mark Estes III (Editor)


A state-of-the-art reference on contemporary and challenging issues in electrocardiography.

Amazingly, over a century after the first use of the electrocardiogram, new ECG patterns are being discovered. And in the last few decades, several new electrocardiographic phenomena and markers have emerged that are challenging to physicians and allied professionals who read and interpret ECGs such as early repolarization, ECGs of athletes, Brugada Syndrome, short and long QT syndrome, various channelopathies, and cardiomyopathies.

Internationally recognized experts discuss the most recent evidence-based information on these new observations, complemented with detailed ECG tracings, to provide essential guidance for the optimal interpretation of ECGs in the 21st century.

Cardiac Surgery in the Adult, Fourth Edition

Cardiac Surgery in the Adult, Fourth Edition
by Lawrence Cohn (Author)


The most authoritative, comprehensive, and current cardiac surgery resource – completely updated and in full color DVD with surgical video clips "...the must-have resource for adult cardiac surgeons around the world. Dr. Cohn...has done a masterful job of keeping this text at the forefront of surgical thought and technique."--Thomas B. Ferguson, MD, Washington University School of Medicine Emeritus (from the foreword) In Cardiac Surgery in the Adult, Fourth Edition, the world’s foremost cardiovascular surgeons and physicians deliver thorough, up-to-date coverage of operative strategy, decision making, technique, and pre- and post-operative management for treating the adult cardiac patient. Editor Lawrence H. Cohn takes you through the optimal treatment of congenital, acquired,...

A Heart Too Good to Die: A Shocking Story of Sudden Cardiac Arrest

A Heart Too Good to Die: A Shocking Story of Sudden Cardiac Arrest
by Jeremy Whitehead (Author)


A must read for heart patients. The lessons of this compelling and amazing story apply to every community in the United States. It offers a poignant, touching glimpse of the inner workings of a family impacted by cardiac arrest.

Cardiac Surgery Essentials For Critical Care Nursing (Hardin, Cardiac Surgery Essentials for Critical Care Nursing)

Cardiac Surgery Essentials For Critical Care Nursing (Hardin, Cardiac Surgery Essentials for Critical Care Nursing)
by Sonya R. Hardin (Author), Roberta Kaplow (Author)


Cardiac Surgery Essentials for Critical Care Nursing is a comprehensive reference that provides a foundation for all cardiac nurses. It is designed to prepare the nurse who is first learning to care for patients undergoing cardiac surgery. It addresses significant changes in cardiac surgery and the nursing responsibilities to meet the needs of these acutely ill patients. Second, the book provides advanced knowledge and a scientific basis for nurses who have mastered the essential knowledge and skills necessary to care for this patient population who now seek more in-depth knowledge base about advances in this dynamic field and strategies to optimize patient outcomes. The emphasis throughout the book is providing an evidence-based foundation for care of the patient during the vulnerable...

Textbook of Neonatal Resuscitation (NRP)

Textbook of Neonatal Resuscitation (NRP)
by American Academy of Pediatrics (Author), American Heart Association (Author)


The new 6th edition textbook with accompanying DVD reflects the 2010 American Academy of Pediatrics and American Heart Association Guidelines for Neonatal Resuscitation.

The new, extensively updated Neonatal Resuscitation Program materials represent a shift in approach to the education process, eliminating the slide and lecture format and emphasizing a hands-on, interactive, simulation-based learning environment. Changes in the NRP™ Algorithm Elimination of Evaluation of Amniotic Fluid in Initial Rapid Assessment Use of Supplemental Oxygen During Neonatal Resuscitation Use of Pulse Oximetry

The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital

The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital
by Alexandra Robbins (Author)


Nursing is more than a career; it is a calling, and one of the most important, fascinating, and dangerous professions in the world. As the frontline responders battling traumas, illnesses, and aggression from surprising sources, nurses are remarkable. Yet contemporary literature largely neglects them.

In THE NURSES, New York Times bestselling author and award-winning journalist Alexandra Robbins peers behind the staff-only door to write a lively, fast-paced story and a riveting work of investigative journalism. Robbins followed real-life nurses in four hospitals and interviewed hundreds of others in a captivating book filled with joy and violence, miracles and heartbreak, dark humor and narrow victories, gripping drama and unsung heroism.

Alexandra Robbins creates...

Cardiac Arrest: The Science & Practice of Resuscitation Medicine

Cardiac Arrest: The Science & Practice of Resuscitation Medicine
by Norman A. Paradis (Editor), Richard M. Nowak (Editor), Henry R. Halperin (Editor)


This volume on cardiac arrest focuses on the pathophysiology and therapy of sudden death. Topics covered include: the pathophysiology of global ischaemia and reperfusion; the therapy of sudden death; and social issues related to sudden death and man's attempt to reverse it.

© 2015 BrightSurf.com