The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
Michael Gerardi - One of the best experts on this subject based on the ideXlab platform.
-
withholding or termination of resuscitation in pediatric out of hospital traumatic Cardiopulmonary Arrest
Pediatrics, 2014Co-Authors: Mary E Fallat, Arthur Cooper, Jeffrey Salomone, David P Mooney, Tres Scherer, David E Wesson, Eileen Bulgar, David P Adelson, Lee S Benjamin, Michael GerardiAbstract:This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic Cardiopulmonary Arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic Cardiopulmonary Arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic Cardiopulmonary Arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has Arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.
Allen W. Heinemann - One of the best experts on this subject based on the ideXlab platform.
-
Outcomes of Cardiopulmonary Arrest in an acute rehabilitation setting.
American journal of physical medicine & rehabilitation, 2001Co-Authors: Kristi L. Kirschner, Chan S. Hwang, Rita K. Bode, Allen W. HeinemannAbstract:Objective: Fifty consecutive cases of Cardiopulmonary Arrest with administration of Cardiopulmonary resuscitation (CPR) during a 6-yr period at a freestanding academic acute rehabilitation hospital were identified. Design: Medical records of 49 patients were available for review. Outcomes of survival of Arrest, survival to 24 hr postArrest, survival to discharge from the hospital were determined, and X 2 or Fisher's exact tests were performed to investigate relationships between survival and admission functional status, age, gender, and medical comorbidities. Results: Forty-three percent of patients survived the initial Arrest, 37% survived to 24 hr post-CPR, and 18% survived to hospital discharge. We were unable to identify any statistically significant predictors of survival post-CPR. Six of the nine survivors returned to the acute rehabilitation setting after Cardiopulmonary Arrest, and five of these patients made significant functional gains. Conclusions: Outcomes after CPR in patients undergoing acute rehabilitation in one setting were not significantly different from those reported for patients in other healthcare settings. These data may be used by healthcare professionals to enhance discussions concerning advance healthcare planning (including resuscitation plans) with patients and families. Larger studies are needed to clarify the prognostic role of prior functional status in predicting CPR outcomes, particularly in the context of various diagnostic categories and age groups.
Mary E Fallat - One of the best experts on this subject based on the ideXlab platform.
-
withholding or termination of resuscitation in pediatric out of hospital traumatic Cardiopulmonary Arrest
Pediatrics, 2014Co-Authors: Mary E Fallat, Arthur Cooper, Jeffrey Salomone, David P Mooney, Tres Scherer, David E Wesson, Eileen Bulgar, David P Adelson, Lee S Benjamin, Michael GerardiAbstract:This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic Cardiopulmonary Arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic Cardiopulmonary Arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic Cardiopulmonary Arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has Arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.
Francis C. Dane - One of the best experts on this subject based on the ideXlab platform.
-
Resuscitation in the Hospital: Circadian Variation of Cardiopulmonary Arrest
The American journal of medicine, 2007Co-Authors: Jennifer L. Jones-crawford, David C. Parish, Betsy Smith, Francis C. DaneAbstract:Abstract Purpose Over 25 reports have found outpatient frequency of sudden cardiac death peaks between 6 am and noon; few studies, with inconsistent results, have examined circadian variation of death in hospitalized patients. This study assesses circadian variation in Cardiopulmonary Arrest of in-hospital patients across patient, hospital, and event variables and its effect on survival to discharge. Methods A retrospective, single institution registry included all admissions to the Medical Center of Central Georgia in which resuscitation was attempted between January 1987 and December 2000. The registry included 4692 admissions; only the first attempt was reported. Analyses of 1-, 2-, 4-, and 8-hour intervals were performed; 1- and 4-hour intervals are presented. Results Significant circadian variation was found at 1 hour (P=.01), but not at 4-hour intervals. Significant circadian variation was found for initial rhythms that were perfusing (P=.03) and asystole (P=.01). A significantly higher percentage of unwitnessed events were found as asystole during the overnight hours (P=.002). Using simple logistic regression, time in 4-hour intervals and rhythm were each significantly related to patient survival until hospital discharge (P=.003 and P Conclusions Circadian variation of Cardiopulmonary Arrest in this hospital has several temporal versions and is related to survival. Late night variation in witnessed events and rhythm suggests a delay between onset of clinical death and discovery, which contributes to poorer outcomes.
Samuel J. Tilden - One of the best experts on this subject based on the ideXlab platform.
-
Outcome and cost at a children's hospital following resuscitation for out-of-hospital Cardiopulmonary Arrest
Archives of pediatrics & adolescent medicine, 1995Co-Authors: Ricardo Ronco, William D. King, Diane K. Donley, Samuel J. TildenAbstract:Objective: To determine the outcome and cost for children resuscitated following out-of-hospital Cardiopulmonary Arrest. Design: Retrospective case series. Setting: An organized prehospital emergency medical system within Birmingham, Ala, in a county with 150 493 children under the age of 15 years. Patients: Sixty-three pediatric victims of out-of-hospital Cardiopulmonary Arrest of any cause presenting to the emergency department of a children's hospital. Intervention: Standard resuscitative techniques were performed for all patients until resuscitative efforts were discontinued in the hospital emergency department or successful resuscitation was achieved. Main Outcome Measures: Successful resuscitation, survival to hospital discharge, neurological outcome, final disposition, and cost of hospital care. Results: Of 63 children with out-of-hospital Cardiopulmonary Arrest treated in the emergency department of a children's hospital, 60 were pulseless and apneic on arrival, 18 (28.6%) were successfully resuscitated and admitted to the intensive care unit, and six (9.5%) were discharged from the hospital. Five of the survivors had severe neurological deficits and one appeared normal. On follow-up, two patients had died (1 month and 7 months after discharge), three were in a vegetative state, and one was normal. The normal patient had successful defibrillation prior to arrival at the emergency department. The average inpatient charge was $10 667 per patient for those who died and $100 000 for those discharged. Conclusions: Aggressive treatment does not lead to intact survival for victims of out-of-hospital Cardiopulmonary Arrest who present to the pediatric emergency department with a preterminal rhythm and absence of spontaneous circulation. Resuscitation efforts in the emergency department are commonly successful but lead to death or severe neurological sequelae at discharge with extremely high cost of care. (Arch Pediatr Adolesc Med. 1995;149:210-214)