Antonio Rodríguez Núñez

A multinational study of thromboprophylaxis practice in critically ill children.

Objectives:Although critically ill children are at increased risk for developing deep venous thrombosis, there are few pediatric studies establishing the prevalence of thrombosis or the efficacy of thromboprophylaxis. We tested the hypothesis that thromboprophylaxis is infrequently used in critically ill children even for those in whom it is indicated. Design:Prospective multinational cross-sectional study over four study dates in 2012. Setting:Fifty-nine PICUs in Australia, Canada, New Zealand, Portugal, Singapore, Spain, and the United States. Patients:All patients less than 18 years old in the PICU during the study dates and times were included in the study, unless the patients were 1) boarding in the unit waiting for a bed outside the PICU or 2) receiving therapeutic anticoagulation. Interventions:None. Measurements and Main Results:Of 2,484 children in the study, 2,159 (86.9%) had greater than or equal to 1 risk factor for thrombosis. Only 308 children (12.4%) were receiving pharmacologic thromboprophylaxis (e.g., aspirin, low-molecular-weight heparin, or unfractionated heparin). Of 430 children indicated to receive pharmacologic thromboprophylaxis based on consensus recommendations, only 149 (34.7%) were receiving it. Mechanical thromboprophylaxis was used in 156 of 655 children (23.8%) 8 years old or older, the youngest age for that device. Using nonlinear mixed effects model, presence of cyanotic congenital heart disease (odds ratio, 7.35; p < 0.001) and spinal cord injury (odds ratio, 8.85; p = 0.008) strongly predicted the use of pharmacologic and mechanical thromboprophylaxis, respectively. Conclusions:Thromboprophylaxis is infrequently used in critically ill children. This is true even for children at high risk of thrombosis where consensus guidelines recommend pharmacologic thromboprophylaxis.

Recomendaciones de expertos sobre el material del carro y mochila de reanimación cardiopulmonar pediátrica y neonatal

Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR.

Hypothermia during vs. after CPR in out of hospital cardiac arrest. Preliminary results of a controlled randomized trial

Luis Sanchez Santos1,∗, Fernando Munoz Agius1, Maria Jose Garcia Monje3, Pablo Vidal Cortes4, Jose Maria Garcia Acuna5, Antonio Rodriguez Nunez5, Eduardo Murias Taboada6, Francisco Javier Rodriguez Farinas7, Carlos Manuel Nieto Mouronte8, Jose Ignacio Cenoz Osinaga9, Marcial Rey Martinez10, Laura Alvarez Montero2, Noelia Vigo Rivas1, Gonzalo Amigo Rodriguez1, Carmen Lopez Unanua1, Maria Pichel Lopez1, Luisa Chayan Zas1, Javier Sanz Smith1, Maria Victoria Barreiro Diaz1, Antonio Iglesias Vazquez1 1 Emergencies Medical System, Galicia, Spain 2 University Hospital Lucas Augusti, Lugo, Galicia, Spain 3 University Hospital of la Coruna, la Coruna, Galicia, Spain 4 University Hospital of Ourense, Ourense, Galicia, Spain 5 University Hospital of Santiago, Santiago (la Coruna), Galicia, Spain 6 University Hospital Group of Vigo, Vigo (Pontevedra) Galicia, Spain 7 Hospital Arquitecto Marcide, Ferrol (la Coruna), Galicia, Spain 8 Hospital of Burela, Burela (Lugo), Galicia, Spain 9 Hospital Montecelo, Pontevedra (Galicia), Spain 10 Povisa Hospital, Vigo (Pontevedra), Galicia, Spain