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Ventilation during cardiopulmonary resuscitation in children: a survey on clinical practice
Rafael González1, Lázaro Pascual1, Alexandra Sava1
1Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, School of Medicine, Complutense University of Madrid, Madrid, Spain.
Insights
Pediatric cardiopulmonary resuscitation (CPR) ventilation practices vary significantly worldwide. Many healthcare professionals do not adhere to international guidelines for ventilation rates and oxygen saturation in children after return of spontaneous circulation (ROSC).
Area of Science:
- Pediatric Critical Care
- Emergency Medicine
- Cardiopulmonary Resuscitation
Background:
- Ventilation management during and after pediatric cardiopulmonary resuscitation (CPR) is critical for patient outcomes.
- Understanding current ventilation practices in pediatric cardiac arrest is essential for guideline development and implementation.
Purpose of the Study:
- To investigate current ventilation strategies employed by healthcare professionals during and after pediatric CPR.
- To identify variations in ventilation practices across different geographical regions and patient demographics.
Main Methods:
- An international online survey was distributed to healthcare professionals involved in pediatric CPR.
- The survey collected data on ventilation rates, oxygen saturation targets, and carbon dioxide management.
- Responses were analyzed from 477 healthcare professionals across 46 countries.
Main Results:
- Significant geographical variations exist in recommended respiratory rates for infants and children.
- A high percentage of respondents (over 40%) targeted oxygen saturation below 94% post-ROSC.
- Adherence to international CPR guidelines for ventilation varied, with notable discrepancies in practice.
Conclusions:
- There is considerable heterogeneity in the ventilation management of pediatric cardiac arrest patients.
- International recommendations for pediatric CPR ventilation are not consistently followed globally.
- Further research and education are needed to standardize ventilation practices and improve outcomes.
Background:
This study aimed to investigate the ventilation practice during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC) in children.
Methods:
An online survey of CPR practices was designed and sent to healthcare professionals treating children.
Results:
A total of 477 healthcare professionals from 46 countries responded to this survey; 92.7% were physicians and 64.2% worked in pediatric intensive care units. Specific CPR guidelines were used by 97.7% of respondents. The respiratory rate most frequently used for children over 12 months was 13 to 20 respirations per minute (rpm) (46% in intubated and 41.8% in non-intubated). For infants under 12 months, the most frequently used respiratory rate was 21 to 30 rpm in intubated patients (37.3%): in non-intubated infants, 13 to 20 rpm (26.5%) and 21 to 30 rpm (26.5%) were used with the same frequency. In North America, the respiratory rate most widely used was 7 to 12 rpm; higher rates (13 to 20 rpm and 21 to 30 rpm) were used in Europe and Latin America (P<0.001). After ROSC, no significant differences in the respiratory rates used were found between the continents. More than 40% of healthcare professionals had a target oxygen saturation below 94%; more than 10% used a target arterial PCO2 below 35 mmHg and more than 13% above 45 mmHg.
Conclusions:
There is considerable variation in the management of ventilation of children in cardiac arrest, and international recommendations are not being followed in a high percentage of cases.
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