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Resuscitation interventions in a tertiary level pediatric emergency department: implications for maintenance of
F Jonathan Guilfoyle1, Ruth Milner, Niranjan Kissoon
1Department of Paediatrics, Division of Emergency Medicine, Alberta Children’s Hospital, Calgary, AB.
Insights
Pediatric emergency resuscitation interventions are infrequent but often successful. Most airway securements and central line placements occurred on the first attempt, suggesting effective pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Resuscitation Science
Background:
- Critical illness requiring resuscitation is uncommon in a pediatric emergency department (PED).
- Understanding the frequency and success rates of interventions is crucial for optimizing care.
Purpose of the Study:
- To quantify the frequency and success rates of resuscitation interventions performed in a pediatric emergency department.
- To analyze the types of diagnoses leading to critical illness and the interventions required.
Main Methods:
- Retrospective chart review of pediatric patients admitted to the pediatric intensive care unit (PICU) from the PED.
- Data collected included demographics, diagnoses, resuscitation interventions, operator training, and number of attempts.
Main Results:
- Of 75,133 PED visits, 304 patients met inclusion criteria. Respiratory distress, trauma, sepsis, and seizures were common diagnoses.
- Ninety-nine patients required intubation, with 81% successful on the first attempt. Other interventions included central line placement, intraosseous needle insertion, inotropes, and chest compressions.
Conclusions:
- Opportunities for advanced resuscitation are limited due to the rarity of critical events in the PED.
- Enhanced training, inter-departmental collaboration (PED and PICU), and established resuscitation protocols may improve outcomes.
Objective:
To describe the frequency and proportion of successful resuscitation interventions in a pediatric emergency department (PED).
Methods And Material:
This was a retrospective chart review of children at the BC Children's Hospital (BCCH) PED who were admitted to the BCCH pediatric intensive care unit (PICU) in 2004 and 2005. Demographic data, diagnosis, and resuscitation interventions in the PED and within the first 24 hours of PICU admission were recorded. The training of the operator and the number of attempts needed were also recorded.
Results:
There were 75,133 PED visits; 304 of 329 (92.4%) who met inclusion criteria were reviewed. Diagnoses included respiratory distress (n=115, 35%), trauma (n=50, 15%), sepsis (n=36, 11%), seizures (n=37, 11%), and cardiac disease (n=22, 7%). Ninety-nine patients required intubation. Intubations in the PED were performed by residents (20%), pediatric emergency medicine (PEM) fellows (15%), PEM attending staff (29%), and PICU fellows (12%); 81% of these were successful on the first attempt. In the PED, seven central lines were placed, seven intraosseous needles were inserted, 15 patients required inotropes, and 9 patients required chest compressions.
Conclusion:
Critical illness in our emergency department is a rare event; hence, opportunities to resuscitate, secure airways, and place central venous catheters are limited. Additional training, close working relationships between the PED and the PICU teams, and resuscitation protocols for early PICU involvement may be needed.
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