Adam W. Lowry

Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids' Inpatient Database*.

Objective:Population-based data on pediatric in-hospital cardiopulmonary resuscitation in the United States are scarce. Single-center studies and voluntary registries may skew the estimated prevalence and outcomes. This study aimed to determine the prevalence and outcomes of pediatric cardiopulmonary resuscitation on a national scale. Design:A retrospective analysis of the Healthcare Cost and Utilization Project 2006 Kids’ Inpatient Database was performed. Sample weighting was employed to produce national estimates. Setting:Three thousand seven hundred thirty-nine hospitals in 38 states participating with the Kids’ Inpatient Database. Patients:All patients <20 yrs of age hospitalized in participating institutions in 2006. Measurements and Main Results:Cardiopulmonary resuscitation was performed in 5,807 (95% confidence interval 5259–6355) children with prevalence of 0.77 per 1,000 admissions. Most patients (68%) were <1 yr old, and 44% were female. On multivariable analysis, cardiopulmonary resuscitation was associated with respiratory failure (odds ratio 41.5, 95% confidence interval 35.4–48.8), myocarditis (odds ratio 36.6, 95% confidence interval 21.9–61.0), acute renal failure (odds ratio 21.6, 95% confidence interval 17.5–26.7), heart failure (odds ratio 3.8, 95% confidence interval 3.0–4.8), and cardiomyopathy (odds ratio 3.8, 95% confidence interval 3.2–4.7). Overall mortality was 51.8% and greater among patients ≥1 yr (68%) vs. <1 yr (44%) (odds ratio 2.7, 95% confidence interval 2.3–3.2). Factors associated with mortality among patients receiving cardiopulmonary resuscitation on multivariable analysis included acute renal failure (odds ratio 1.5, 95% confidence interval 1.1–1.9), hepatic insufficiency (odds ratio 1.5, 95% confidence interval 1.01–2.4), sepsis (odds ratio 1.2, 95% confidence interval 1.01–1.4), and congenital heart disease (odds ratio 1.2, 95% confidence interval 1.01–1.5). Conclusions:Cardiopulmonary resuscitation is performed in approximately one in 1,300 pediatric hospitalizations. Approximately half of patients receiving cardiopulmonary resuscitation do not survive to discharge. Independent risk factors for mortality after receiving cardiopulmonary resuscitation included congenital heart disease, age ≥1 yr, acute renal failure, hepatic insufficiency, and sepsis.

Cardiopulmonary resuscitation in hospitalized children with cardiovascular disease: estimated prevalence and outcomes from the kids' inpatient database.

Objective: Hospitalized children with cardiovascular disease may be at increased risk of cardiac arrest; however, little data exist regarding prevalence, risk factors, or outcomes of cardiopulmonary resuscitation in these patients. We sought to characterize national estimates of cardiopulmonary resuscitation and death after cardiopulmonary resuscitation for hospitalized children with cardiovascular disease. Setting: A total of 3,739 hospitals in 38 states participating in Kids’ Inpatient Database. Design: Retrospective analysis of the 2000, 2003, and 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database was performed. Sample weighting was employed to produce national estimates. Measurements and Main Results: Cardiovascular disease was identified in 2.2% of the estimated 22,175,468 (95% confidence interval 21,391,343–22,959,592) hospitalizations. Cardiopulmonary resuscitation occurred in 0.74% (3,698; 95% confidence interval 3,205–4,191) of hospitalizations of children with cardiovascular disease, compared with 0.05% (11,726; 95% confidence interval 10,647–12,805) without cardiovascular disease (odds ratio 13.8, 95% confidence interval 12.8–15.0). The highest frequency of cardiopulmonary resuscitation occurred with myocarditis (3.0% of admissions), heart failure (2.0%), and coronary pathology (2.0%). Compared with other forms of cardiovascular disease identified in this study, single-ventricle patients were the only subgroup who exhibited a higher mortality after cardiopulmonary resuscitation (mortality 65% vs. 55%; odds ratio 1.7 [95% confidence interval 1.2–2.6]), while those who had undergone cardiac surgery exhibited a lower mortality rate (mortality 48% vs. 57%; odds ratio 0.6 [95% confidence interval 0.5–0.8]). Conclusions: Cardiopulmonary resuscitation occurs in approximately 7 per 1,000 hospitalizations of children with cardiovascular disease, a rate greater than ten-fold that observed in hospitalizations of children without cardiovascular disease. Single-ventricle patients demonstrated increased mortality after cardiopulmonary resuscitation, while recent cardiac surgery was associated with a reduced odds of death after cardiopulmonary resuscitation. Further studies are needed to confirm these findings and develop techniques to prevent cardiac arrest in this high-risk population.

The Potential to Avoid Heart Transplantation in Children: Outpatient Bridge to Recovery with an Intracorporeal Continuous-Flow Left Ventricular Assist Device in a 14-Year-Old

Pediatric mechanical circulatory support has evolved considerably in the past decade. Improvements in device design and availability have led to increased short-, medium-, and long-term support options for pediatric patients with heart failure. Most pediatric mechanical circulatory support is utilized as a bridge to transplant and as a bridge to recovery in patients with temporary etiologies of heart failure (i.e., myocarditis). Described herein is our recovery program, and we report our experience as an independent pediatric ventricular assist device program with an intracorporeal continuous-flow device employed as an out-of-hospital bridge to recovery for a child with end-stage chronic heart failure.

Getting kids from the Big Easy hospitals to our place (not easy): preparing, improvising, and caring for children during mass transport after a disaster.

The incapacitating blows dealt to the New Orleans, Louisiana, health care infrastructure by Hurricane Katrina and its aftermath are unprecedented in the United States. Much can be learned about disaster preparedness from the events that unfolded in New Orleans after Katrina swept the Gulf shoreline. Problem areas in the management of this disaster such as internal and external communication failures, transportation, triage, personnel allocation, and resource allocation have long been identified in the literature as core disaster-response issues.1–3 In addition, damage to the physical plant, water and power system failures, and hazardous-materials exposure are encountered commonly in the face of disaster.1 Between 1950 and 2005, 286 hospital evacuations have been described, including horizontal evacuation (within the same floor), vertical evacuation (between floors), evacuation of a ward or wing, and complete hospital evacuation.4–10 Of the 286 between 1971 and 1999, 275 were reviewed by Sternberg et al.8 There are 22 reported cases of complete hospital evacuation since 1950; of these, 1 occurred in Canada and 8 resulted from the 1994 Northridge, California, earthquake.4,5,7–18 Of 43 reported incidents for which duration is known, only 12 evacuations lasted longer than 24 hours.8 Eleven percent of evacuations in the series reviewed by Sternberg et al listed at least 1 casualty, and the deadliest reported hospital disaster occurred in 1971, when partial collapse of a California Veterans Administration hospital claimed 49 lives.8 Hurricanes are the third most common cause for hospital evacuation, accounting for 38 of 286 reported evacuations; only internal fire and internal hazardous-material events are more common. It is notable that only 3 evacuations since 1950 involved 1000 or more patients.8 Over a 5-day span in June 2001, Tropical Storm Allison brought nearly 39 inches … Address correspondence to Susan M. Distefano, MSN, RN, CNAA, BC. E-mail: smdistef{at}texaschildrenshospital.org

Coronary Artery Anatomy in Congenital Heart Disease

Expanded surgical options and improved outcomes for children born with structural heart defects have ushered a greater clinical interest in the normal and abnormal development of the coronary circulation. Anatomic variations of the coronary system may impact surgical candidacy or operative technique during neonatal life, while others may impact long-term clinical management and planning for subsequent interventions. This review aims to characterize coronary artery anatomy in symptomatic congenital heart disease, emphasizing the clinical consequence of these variations and anomalies.

Resuscitation and perioperative management of the high-risk single ventricle patient: first-stage palliation.

Infants born with hypoplastic left heart syndrome or other lesions resulting in a single right ventricle face the highest risk of mortality among all forms of congenital heart disease. Before the modern era of surgical palliation, these conditions were universally lethal; recent refinements in surgical technique and perioperative management have translated into dramatic improvements in survival. Nonetheless, these infants remain at a high risk of morbidity and mortality, and an appreciation of single ventricle physiology is fundamental to the care of these high-risk patients. Herein, resuscitation and perioperative management of infants with hypoplastic left heart syndrome are reviewed. Basic neonatal and pediatric life support recommendations are summarized, and perioperative first-stage clinical management strategies are reviewed.

Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals.

OBJECTIVE To assess how obesity or diabetes mellitus impacts outcomes in patients undergoing cardiac surgery in pediatric hospitals. DESIGN A multi-institutional, matched case-control study of the Pediatric Health Information System database was performed. SETTING Tertiary childrens hospitals in the United States. PATIENTS All cardiac surgical cases in patients with obesity or diabetes mellitus between 2004 and 2012 were included. Cases were matched to controls by age, sex, race, and Risk Adjustment for Congenital Heart Surgery score. OUTCOME MEASURES Mortality, surgical complications, and hospital utilization. Differences in outcome measures were assessed by chi-square and Mann-Whitney tests. P value < .05 was significant. RESULTS Six hundred twenty-nine cardiac surgical cases (median age 17 years [IQR 12-32]) with obesity or diabetes mellitus were matched to 629 controls. Cases demonstrated lower median household income than those in the control group (

Variability in delivery of care and echocardiogram surveillance of Kawasaki disease.

38,031 [IQR

Percutaneous Atrial Septal Defect Closure in a Child with Interrupted Inferior Vena Cava: Successful Femoral Venous Approach

31,900-

Uhl’s anomaly: A one and a half ventricular repair in a patient presenting with cardiac arrest

48,844] vs. (