The aim of this research is to enhance therapeutic outcomes in children diagnosed with severe craniocerebral trauma by evaluating the contributing factors involved in cerebral injury. The investigation focused on evaluating the impact of infusion therapy on the improvement of pediatric patients' conditions with SCCT, particularly by assessing hydrobalance indicators. Adaptive changes associated with the humoral stress response were evaluated through alterations in hormone concentrations (thyrotropin (TSH), cortisol (C), prolactin (P)). Concentrations of plasma protein and glucose were analyzed. A total of 804 children with isolated severe craniocerebral trauma (SCCT) were enrolled and stratified into retrospective (n = 474) and prospective (n = 100) cohorts. Children with negative hydrobalance exhibited a higher mortality rate compared to those with positive hydrobalance (24% vs. 10%, p ≤ 0.05). Positive hydrobalance, in conjunction with appropriate infusion therapy and rehydration, positively influenced the prognosis of severe cranio-cerebral trauma (SCCT). These findings can be applied in clinical practice to optimize the treatment of children with SCCT and improve their prognosis. The level of total protein was higher in conscious children after 48 h (59.9 ± 1.5 g/L, p ≤ 0.05) in comparison to deceased individuals (54.9 ± 1.6 g/L, p ≤ 0.05). Stress-induced hyperglycemia was associated with the severity of severe cranio-cerebral trauma. The study corroborated the significance of infusion therapy in the treatment of children with SCCT. Indicators of total protein, glucose, and P concentrations can serve as valuable tools for assessing the severity and prognostication of SCCT.

Pediatric cardiac arrest is associated with high mortality and significant morbidity among survivors. International guidelines for prognostication remain limited due to small heterogeneous patient populations, variable post-return of circulation diagnostics, and insufficient long-term follow-up. Pediatric Resuscitation Prognostication and Outcomes Registry (PROGNOSE) is a Dutch nationwide, multicenter registry aiming to standardize data collection, establish uniform neuromonitoring reporting, and implement structured follow-up protocols.

The Pediatric Resuscitation Prognostication and Outcomes Registry (ClinicalTrials.gov ID: NCT06938009) collects data on pediatric cardiac arrest across Dutch pediatric intensive care units, extending the pediRES-Q collaborative. It includes patients <18 years with out-of-hospital cardiac arrest requiring emergency services and in-hospital cardiac arrest patients admitted to academic hospitals. Return of circulation is defined as sustained spontaneous circulation or via extracorporeal support. Exclusions include pre-existing Do Not Resuscitate orders or neonates < 24 h. The registry captures pre-hospital factors, resuscitation characteristics, post-return of circulation care, neuroprognostication markers (biomarkers, electroencephalography, imaging), and long-term outcomes. Structured follow-up occurs at 3-6 months, 12 months, and evaluations through age 17 for neurodevelopmental, psychosocial, and functional outcomes.

The Pediatric Resuscitation Prognostication and Outcomes Registry (PROGNOSE) represents the first nationwide initiative to standardize data collection on pediatric cardiac arrest, post-return of circulation care and implement structured follow-up protocols in the Netherlands. This registry aims to address critical knowledge gaps, providing foundation for evidence-based prognostication, clinical decision-making, and long-term care policy recommendations. Future expansion efforts will focus on integrating pre-hospital data, extending follow-up into young adulthood, and strengthening international collaboration through the pediRES-Q network.

The System-wide Paediatric Observation Tracking (SPOT) programme in England aims to improve the recognition of, and response to, deterioration in the health status of children and young people in any healthcare environment. The first phase of the programme involved the development of a standardised inpatient chart and track and trigger system, or Paediatric Early Warning System (PEWS), for England. This is the first of two articles that aim to develop nurses' knowledge and understanding of the SPOT programme and the PEWS to assist them in providing safe and effective care to children and young people. This first article describes the assessment, documentation and scoring of a child's vital signs and observations to calculate a PEWS score, which indicates the required escalation level and corresponding actions to take. The article also outlines the assessment and documentation of other important physiological parameters that do not contribute to the PEWS score but inform the escalation level and actions to take.

Ventilation is important in out-of-hospital cardiac arrest resuscitation; however, few studies describe ventilation rates during pediatric out-of-hospital cardiac arrest (pOHCA). Our objective was to characterize ventilations and end-tidal capnography (EtCO2) after advanced airway placement by emergency medical services (EMS) during pOHCA resuscitation.

This was a retrospective cohort study that included pediatric (age <18 years) non-traumatic OHCA treated by an urban fire-based EMS system (Columbus Division of Fire, Columbus, Ohio) from April 2019 to December 2020. We identified ventilations delivered during resuscitation by manual review of continuous EtCO2 recorded by cardiac monitors. We also identified ventilations using automated detection algorithms previously validated in adult resuscitation. Mean ventilation rate and EtCO2 were summarized in one-minute (min) epochs from advanced airway insertion through end of resuscitation efforts. We compared return of spontaneous circulation (ROSC) vs non-ROSC ventilation rates using Student's t-tests. Cochran-Armitage test of trend was used to evaluate EtCO2 temporal trends. Associations between ROSC and EtCO2 were tested using a regression model.

We identified 38 pOHCA cases and 30 cases were included for ventilation analysis. Cases were primarily infants (0.7 years, IQR 0.17-2), male (52.6%) and African-American race (63.1%). Most pOHCAs were unwitnessed (65.8%) with non-shockable rhythms (94.8%) and infrequent bystander cardiopulmonary resuscitation (31.2%). Eight patients achieved ROSC (21.2%) and two patients survived (5.3%). Advanced airway attempts included supraglottic airway devices (71.1%), endotracheal intubation (7.8%) or both (7.8%). Ventilation rates ranged from 0-23 per minute. Automated ventilation detection algorithms performed well in pediatric ventilation detection where the mean standard error was 3.7mmHg in EtCO2 values and 1.3 per minute in ventilation rates. Ventilation rates differed between ROSC and non-ROSC groups (9.2 vs 6.9 per min, p < 0.001). Ranges of EtCO2 values included 0-100 mmHg during resuscitation. The EtCO2 trends over time differed between ROSC and non-ROSC groups (59.82 mmHg to 75.9 mmHg vs 20.7 mmHg to 19.0 mmHg, p < 0.01). EtCO2 was significantly associated with ROSC (OR 1.0 95% CI 1.00-1.01, p < 0.001).

These results offer one of the first perspectives of ventilation in pOHCA. Differences were observed in ventilation rates and EtCO2 trends between ROSC and non-ROSC cases.

Predicting fluid responsiveness is challenging in infants. It is however crucial to avoid unnecessary volume expansion, which can lead to fluid overload. We tested the hypothesis that the stroke volume changes induced by a calibrated abdominal compression (ΔSV-AC) could predict fluid responsiveness in infants without cardiac disease.

This prospective single center study of diagnostic test accuracy was conducted in a general pediatric intensive care unit (PICU). Children under the age of two with acute circulatory failure and requiring a 10 mL.kg-1 crystalloid volume expansion over 20 min, ventilated or not ventilated, were eligible. Stroke volume was measured by transthoracic echocardiography at baseline, during a gentle calibrated abdominal compression (22 mmHg for 30 s), and after volume expansion. The area under the receiver operating characteristic curve (AUROC) of ΔSV-AC was measured to predict fluid responsiveness, defined as a 15% stroke volume increase after volume expansion.

Twenty-seven cases of volume expansion were analyzed, in 21 patients. Seventeen VE cases were administrated to spontaneously breathing children. Fluid responsiveness was observed in 12 cases. The AUROC of ΔSV-AC was 0.93 (95% confidence interval (95%CI) 0.82-1). The best threshold value for ΔSV-AC was 9.5%. At this threshold value, sensitivity was 92% (95%CI 62-100), specificity was 87% (95%CI 60-98), positive and negative predictive values were 85% (95%CI 60-95) and 93% (95%CI 66-99) respectively.

Echocardiographic assessment of stroke volume changes induced by a calibrated abdominal compression is a promising method to predict fluid responsiveness in infants without cardiac disease hospitalized in PICU.

ClinicalTrials.gov registration number NCT05919719, June 22, 2023, retrospectively registered, https://clinicaltrials.gov/study/NCT05919719 .

In pediatric patients, the choice of the venous access device currently relies upon the operator's experience and preference and on the local availability of specific resources and technologies. Though, considering the limited options for venous access in children if compared to adults, such clinical choice has a great critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems fully satisfactory and useful in clinical practice. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in children. After a systematic review of the available evidence, the panel of the consensus (which included Italian experts with documented competence in this area) has provided structured recommendations answering 10 key questions regarding the choice of venous access both in emergency and in elective situations, both in the hospitalized and in the non-hospitalized child. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.

Identifying and managing medical emergencies presents challenges in healthcare, where familiarity with established algorithms is essential for high-quality care. This study assessed healthcare professionals' understanding of the latest resuscitation guidelines and explored their views on lifelong training models.

This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation (ILCOR). Healthcare staff involved in emergency coverage completed assessments on emergency management, self-evaluated their knowledge, and shared perspectives on continuous workplace education.

Of the 1,427 distributed questionnaires, 1,034 (72.5%) were completed. Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001). In multivariate logistic regression, being a physician, holding a Master of Science (MSc) degree, and younger age were independently associated with passing scores ≥70% (all P<0.001). Most participants (97.3%) favored brief, employer-funded teamwork refresher sessions every 4-6 months over the current four-year training model (0.6%) (P<0.001).

This study highlights healthcare life support providers' insufficient expertise in current resuscitation guidelines. The importance of short-format retraining, upskilling, and reskilling programs with post-training assessments is evident, as most respondents expressed a strong learning motivation to participate if employer-funded.

Current guidelines advise rescuers to initiate cardiopulmonary resuscitation if a child is unresponsive, not breathing normally, and shows no signs of life. Manual pulse checks are considered unreliable and time-consuming. This systematic review evaluates the accuracy and duration of recommended pulse check methods during pediatric cardiac arrest and explores emerging diagnostic techniques.

For this systematic review (PROSPERO ID CRD42024549535) three databases (PubMed, Embase, and Cochrane) were searched for articles published on this topic. An initial search was conducted on April 24, 2024, with an updated search using the same search strategy on February 16, 2025. Two authors independently screened the articles. One author extracted the data while a second author double-checked it. Quality and certainty of the evidence were evaluated using the QUADAS-2 and GRADE tools evaluated the evidence's quality and certainty. Studies were included if they compared manual pulse checks against alternative pulse check sites or other methods in pediatric patients. The data is presented descriptively.

A total of three studies were included. These studies involved 39 pediatric patients and a total of 376 pulse checks. Out of the 47 infants and children included, only 14 were in cardiac arrest. The remaining 33 patients were on mechanical circulatory support with either VA-ECMO or LVAD. In total, 183 nurses and 181 physicians performed 376 pulse or ultrasound checks. Due to their specialty, 122 nurses and 89 doctors were classified as experienced. Sensitivity and specificity of manual pulse check ranged from 76 to 100% and 64-79%, respectively. When experienced providers conducted pulse checks, sensitivity and specificity were higher (76-100% and 62-82%, respectively) compared to inexperienced providers (67-82% and 44-95%).The mean duration of pulse checks was 20 s, with an accuracy of 85%.

Despite high heterogeneity among included studies, manual pulse checks only achieved moderate accuracy with a prolonged duration. This suggests that manual pulse checks are unreliable in children for determination cardiac arrest state and need for ongoing CPR.

The French Society of Anesthesiology and Critical Care (Société Française d'Anesthésie et de Réanimation (SFAR)) and the French association of paediatric intensive care anaesthetists (Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF)) have joined forces to provide guidelines for professional practice on the structural, material, and functional organisation of centres performing pediatric anesthesia.

A consensus committee of 16 experts from the SFAR and the ADARPEF was convened. The experts declared no conflict of interest before and throughout the process. The entire guidelines process was conducted independently of any industry funding. The authors were asked to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence.

Four fields were defined: (1) structure and logistics; (2) equipment and materials; (3) training; and (4) functional organisation. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out on works published from 2000 to 2022, using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. Because of the very small number of studies that could provide the necessary power for the most important endpoint (i.e., morbidity), it was decided, before drafting the recommendations, to adopt a Recommendations for Professional Practice (RPP) format rather than a Formalised Recommendations of Experts (RFE) format. The recommendations were formulated according to the GRADE® methodology, before being voted on by all the experts according to the GRADE grid method.

The experts' synthesis work and the application of the GRADE® method resulted in 34 recommendations dealing with the structural, material and functional organization of centers performing pediatric anaesthesia. After three rounds of rating and several amendments, an agreement was reached on all the recommendations.

Strong agreement exists among the experts to provide recommendations aimed at improving the structural, material and functional organization of centers performing paediatric anaesthesia.

Although the end-tidal carbon dioxide concentration (ETCO2) recorded during resuscitation has been reported as an indicator of survival in a few studies of pediatric in-hospital cardiac arrest, the relationship between ETCO2 and survival in pediatric out-of-hospital cardiac arrest (OHCA) has not previously been investigated (particularly with regard to the cause of the OHCA). This study aimed to determine whether quantitative measurement of ETCO2 during resuscitation is predictive of survival in cases of pediatric OHCA.

This nationwide, population-based cohort study analyzed data from the French RéAC OHCA registry, including all patients under 18 years of age with trauma-related OHCA or medical OHCA from 2011 to 2023. The highest ETCO2 value was recorded during advanced cardiopulmonary resuscitation. The main outcomes were return of spontaneous circulation (ROSC) and day (d)30 survival. Discriminant ability was evaluated using the area under the receiver operating characteristic curve (AUROC), and the Youden index was used to determine the optimal ETCO2 cut-off value.

A total of 1209 pediatric OHCAs (226 (19%) trauma-related and 983 (81%) medical) were included. The victims' median [interquartile range] age was 6 [0;14] years. ROSC was achieved in 347 (29%) cases and d30 survival was achieved in 61 (5%) cases. In both trauma-related and medical OHCAs, the peak recorded ETCO2 value was higher in patients who achieved ROSC and in d30 survivors. The AUROC [95% confidence interval] for the highest ETCO2 that predicted ROSC and d30 survival were respectively 0.808 [0.745-0.872] and 0.854 [0.761-0.947] for the trauma-related OHCA group and 0.803 [0.774-0.831] and 0.732 [0.676-0.787] for the medical OHCA group. In both groups, the probability of ROSC and d30 survival increased with higher ETCO2 values, with optimal cut-offs of 21 and 29 mmHg for trauma-related OHCA and 27 and 26 mmHg for medical OHCA, respectively.

Further studies are necessary to clarify the use of ETCO2 in optimizing pediatric ALS.

To assess whether the two-person ventilation technique during simulated neonatal resuscitation enables higher ventilation quality compared with the one-person technique, as measured by expiratory tidal volume (eVT), mask leak, positive inspiratory pressure, respiratory rate, and minute ventilation.

We conducted a randomized, cross-over simulation trial including 74 neonatal care providers at the Neonatal Simulation Center, Children's Hospital of Philadelphia. Participants performed bag-mask ventilation using one-person and two-person techniques in a randomized order. Ventilation parameters were recorded using a respiratory function monitor. Visual attention was analyzed using eye-tracking technology. The primary outcome was the time to achieve effective ventilation defined by eVT between 4-8 ml/kg and mask leak ≤30% for 10 consecutive seconds.

No participant achieved the primary ventilation target in either technique. The two-person technique showed higher eVT (9.7 mL/kg vs 8.4 mL/kg, absolute difference -1.3 mL/kg, 95% CI [-2.4, -0.1], P = .032) and a significant reduction in mask leak (48.9% vs 62.9%, absolute difference of 14.0%, 95% CI [6.4, 22.0], P < .001). Eye-tracking indicated differing visual attention patterns between techniques, with the two-person technique focusing more on the mask and bag (dwell time: 25% one-person vs 34% two-person, P = .13).

The two-person ventilation technique was associated with increased eVT and decreased mask leak during simulated neonatal resuscitation. Further research is needed to evaluate the impact of different ventilation devices and techniques in clinical settings.

Since this was a simulation-based study, registration in a clinical trial registry was not required.

Background/Objectives: Effective infant cardiopulmonary resuscitation (CPR) relies on high-quality chest compressions, yet the optimal technique for single-rescuer scenarios remains debated. Although widely used, the two-finger technique (TFT) is associated with an inadequate compression depth and increased rescuer fatigue. While the two-thumb encircling hands technique (TTHT) provides a superior compression depth, its application in single-rescuer scenarios is impractical. This study evaluates a novel technique (nT) as a potential alternative, aiming to optimize both compression efficacy and rescuer endurance. Methods: This randomized crossover study assessed the efficacy of the TFT, TTHT, and nT in a simulated infant CPR setting. Medical students trained in newborn and infant resuscitation performed all three techniques in a controlled environment using a high-fidelity neonatal simulator. We objectively measured and compared key CPR performance metrics, rescuer fatigue, and hand pain among the techniques. Results: The nT and TTHT outperformed the TFT in compression depth, rescuer endurance, and overall CPR quality. The nT achieved the highest adequate compression rate (92.4% vs. 78.6% for TTHT and 65.2% for TFT) while minimizing fatigue (RPE: 3.1 vs. 4.5 for TTHT and 6.2 for TFT) and hand pain (NRS: 1.8 vs. 3.9 for TTHT and 5.4 for TFT). TTHT produced the deepest compressions (mean: 44.2 mm vs. 42.9 mm for nT and 38.6 mm for TFT, p < 0.001). Rescuer anthropometric factors (sex, weight, and height) affected all techniques similarly, suggesting no inherent advantage based on body characteristics. Conclusions: Both the nT and TTHT outperformed the TFT, with the nT demonstrating superior rescuer endurance while maintaining high-quality compressions. Given its ergonomic benefits and effectiveness, the nT emerges as a promising alternative for single-rescuer infant CPR and warrants consideration for future resuscitation guidelines.

This study aims to quantify the reliability of automated external defibrillators (AED) in paediatric out-of-hospital cardiac arrests (pOHCA) by evaluating the defibrillation and the shock advisory system efficacy. Furthermore, the relationship between the initial energy dose and patient outcomes is analysed.

We studied data from all pOHCA cases (age < 18 years) treated by the Paris Fire Brigade between January 2010 and December 2018, limited to those with available AED signals. The efficacy of shocks is the primary outcome. The secondary outcomes are the shock advisory system performance, pre-hospital return of a spontaneous circulation (ROSC), survival and energy dose. Energy dose, weight and age are compared using a Wilcoxon test according to the outcome's values.

A total of 1,990 electrocardiogram strips extracted from 349 pOHCA cases were included in the study. Shock advisory system had a sensitivity of 89.4% and a specificity of 99.8% for the detection of shockable rhythms. Shock efficacy observed for all patients who received a shock was 83.1% and first shock efficacy for patients in initial ventricular fibrillation was 96%. Patients who received a shock had a pre-hospital ROSC rate of 74.3%, a survival rate at hospital admission of 71.4% and 34.3% at hospital discharge.

This study shows that AED detect shockable rhythm with a good sensitivity and specificity and that shocks are associated with a very high rates of termination of shockable rhythms in pOHCA.

Intraosseous access (IO) is a crucial, life-saving alternative vascular access in paediatric emergency medicine. In awake paediatric patients, the pain of drilling and flushing the marrow cavity are barriers to the use of the IO method or prompt the use of an intraosseous anaesthetic agent, which introduces the risk of dosing errors and drug toxicity. This study aims to identify the frequency of use of anaesthetic agents and analyse the time delay caused by their use.

Prospective surveillance study analysing all patients, aged > 28 days to 18 years, who received one or more IO attempt(s) in and out of the hospital setting in Germany from 1 July 2017 to 30 June 2019 via the reporting mechanism of the German Paediatric Surveillance Unit (GPSU).

Our analysis identified 74 patients who received an IO attempt while awake. All patients were younger than 6 years old. Almost every third child (31.6%) was awake during IO use. In 18.9% of all awake patients, an intraosseous anaesthetic was used before the IO was drilled or the marrow cavity was flushed, introducing a significant time delay of approximately 3 min (p = 0.001) compared to IO attempts without intraosseous anaesthesia.

Intraosseous anaesthesia prolongs the establishment of working vascular access in an emergency and introduces the risk of drug toxicity. To prevent adverse events, particular emphasis must be placed on placement without intraosseous anaesthesia, and alternative pain management (intranasal) must be considered if necessary. Training courses and guidelines should reflect the advised current practice.

Pediatric drowning incidents, both fatal and non-fatal, represent a significant challenge in emergency medicine, particularly for children under 14 years of age. Drowning is a leading cause of unintentional injury-related deaths, with children aged one to four years being especially vulnerable. Accurate and timely assessment, particularly through chest imaging, such as chest radiography (CXR) and lung point-of-care ultrasound (LUS), is crucial for evaluating pulmonary complications and guiding treatment decisions. This retrospective study analyzed 64 pediatric drowning cases in Istituto Giannina Gaslini, Italy, from 2012 to 2023. For all patients, demographic data, vital parameters, blood tests upon PED admission and at 24 h, need for intensive care unit admission, length of stay, therapies administered, ventilatory support in the PED and in the hospital ward, and mortality were recorded. The patients were subsequently divided into two groups based on the chest X-ray result. The results indicated that pathological CXR findings upon admission were associated with a higher likelihood of hospital admission, prolonged hospital stay, and more severe clinical outcomes, including the need for oxygen supplementation and antibiotic therapy. Patients with abnormal CXR findings also exhibited lower oxygen saturation, Glasgow Coma Scale scores, and body temperature upon admission, reflecting a more significant physiological compromise, and higher RCP values at 24 h.

Although the majority of non-fatal drowning patients recovered without lasting neurological deficits, the findings suggest that CXR plays a critical role in early management, assisting in the identification of those at greater risk for complications.

• Fatal and non-fatal pediatric drowning incidents may represent a critical issue in pediatric emergency medicine, requiring prompt assessment and accurate management upon admission, even if standardized protocols are lacking.

• Chest imaging in the initial assessment of pediatric drowning cases may serve as a fundamental tool to support early clinical decision-making, particularly when integrated with other key parameters such as neurological status, vital signs, and blood exams.

This study investigated the use of a respiratory function monitor (RFM) to guide the placement of a supraglottic airway device (SAD) in neonates during intensive care interventions. We hypothesized that using a RFM would decrease the number of attempts needed for a successful placement.

This single-center pilot study was carried out at a tertiary NICU at the Medical University of Vienna. Patients were ventilated using a SAD during neurosurgical or endoscopic interventions. A RFM was either hidden (but recording) or visible to providers during SAD placement. Feedback from the RFM was used to assess correct/incorrect placement and optimize ventilation quality. The parameter leakage was used for assessment: if leak was <30%, correct placement was assumed. The primary outcome was the number of attempts until correct placement. Secondary outcomes included ventilation parameters recorded by the RFM and the duration of SAD placement.

Six patients were included in this pilot trial. Using a RFM to guide SAD placement led to fewer attempts (median attempts: 3 [hidden] vs. 1 [visible]). Furthermore, using the RFM, necessary adaptations were made to the SAD position to decrease leakage (mean leakage: 74.8% [hidden] vs. 17.8% [visible]), subsequently endoscopy after insertion of SAD using the RFM then confirmed anatomically correct position.

This pilot study indicated that a RFM might be useful to provide guidance during SAD placement.

Feedback from a RFM reliably indicated correct anatomical placement of a SAD by correlating low leakage values with proper SAD positioning. RFM guidance could improve neonatal airway management, reducing procedural time and number of attempts. We present promising preliminary results. Further research is needed to confirm these findings.

Current Pediatric Advanced Life Support Guidelines recommend maintaining blood pressure (BP) above the 5th percentile for age following return of spontaneous circulation (ROSC) after cardiac arrest (CA). Emerging evidence suggests that targeting higher thresholds, such as the 10th or 25th percentiles, may improve neurologic outcomes. We aimed to evaluate the association between post-ROSC BP thresholds and neurologic outcome, hypothesizing that maintaining mean arterial pressure (MAP) and systolic blood pressure (SBP) above these thresholds would be associated with improved outcomes at hospital discharge.

This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC following index in-hospital or out-of-hospital cardiac arrest and survived ≥ 6 h were included. Multivariable logistic regression was preformed to analyze the association between the pre-defined BP thresholds (5th, 10th, and 25th percentiles) and favorable neurologic outcome, controlling for illness category (surgical-cardiac), initial rhythm (shockable), arrest time (weekend or night), age, CPR duration, and clustering by site.

There were 787 patients with evaluable MAP data and 711 patients with evaluable SBP data. Fifty-four percent (N = 424) of subjects with MAP data and 53 % (N = 380) with SBP data survived to hospital discharge with favorable neurologic outcome. MAP above the 5th, 10th, and 25th percentile thresholds was associated with significantly greater odds of favorable outcome compared to patients with MAP below target (aOR, 1.81 [95 % CI, 1.32, 2.50]; 1.50 [95 % CI, 1.10, 2.05]; 1.40 [95 % CI, 1.01, 1.94], respectively). Subjects with lowest SBP above the 5th percentile also had greater odds of favorable outcome (aOR, 1.44 [95 % CI, 1.04, 2.01]). Associations between lowest SBP above the 10th percentile and 25th percentile did not reach statistical significance (aOR 1.33 [95 % CI, 0.96, 1.86]; 1.23 [95 % CI, 0.87, 1.75], respectively).

After pediatric CA, maintaining MAP above the 5th, 10th, and 25th percentiles and SBP above the 5th percentile during the first 6 h following ROSC was significantly associated with improved neurologic outcomes.

We aimed to measure the effect of a 2-day structured paediatric simulation-based training (SBT) on basic and advanced airway management during simulated paediatric resuscitations.

Standardised paediatric high-fidelity SBT was conducted in 12 of the 15 children's hospitals in Hesse, Germany. Before and after the SBT the study participants took part in two study scenarios (PRE and POST scenario), which were recorded using an audio-video system. Airway management was assessed using a performance evaluation checklist. Time to initiate ventilation, frequency, and timing of endotracheal intubation (ETI), and its influence on other life support interventions were assessed. Differences in airway management between hospitals with and without a PICU were evaluated.

Two hundred twenty-nine participants formed 58 interprofessional resuscitation teams. All teams recognised apnoea in their simulated patients and initiated ventilation during the scenarios. Time to recognition of apnoea and time to initiation of ventilation did not improve significantly after SBT, but teams were significantly more likely to select appropriately sized airway equipment. ETI was attempted in 55% PRE and 40% POST scenarios (p=0.1). The duration of the entire ETI process was significantly shorter in the POST scenarios. Chest compressions (CC) were frequently discontinued during ETI attempts, which improved after SBT (PRE 73% vs. POST 43%, p = 0.035). Adequate resumption of CC after completion of intubation was also significantly more frequent in the POST scenarios (46% vs. 74%, p = 0.048). During ETI attempts, CC were more likely to be adequately continued in teams from hospitals with a PICU (PRE scenarios: PICU 20% vs. NON-PICU 36%; POST scenarios: PICU 79%, NON-PICU 22%; p < 0.01).

Our data suggest an association between airway management complexity and basic life support measures. Although the frequency of ETI was not significantly reduced after a 2-day SBT intervention, the duration of advanced airway management was shortened thus reducing no-ventilation time which led to fewer interruptions in chest compressions during simulated paediatric resuscitations. SBT may be adapted to the participants' workplace to maximize its effect and improve the overall performance in paediatric resuscitation.

Paediatric myocarditis is a challenging and heterogeneous condition, with varied clinical presentations ranging from mild symptoms to life-threatening complications such as heart failure, arrhythmias, and sudden cardiac death. Effective management hinges on early diagnosis, appropriate treatment, and ongoing monitoring, which can be significantly enhanced through multimodal imaging techniques. This review emphasizes the crucial role of advanced imaging in the diagnosis, prognostication, and management of paediatric myocarditis. While traditional echocardiography remains the first-line imaging tool, it is often insufficient in detecting subtle myocardial changes and it does not allow the identification of myocardial inflammation and fibrosis, particularly in cases with preserved left ventricular function. Recent advancements, including speckle-tracking echocardiography, provide enhanced sensitivity for detecting early signs of myocardial dysfunction, even in the absence of overt abnormalities. Cardiovascular magnetic resonance (CMR) has emerged as a cornerstone in the non-invasive evaluation of myocarditis, offering unparalleled tissue characterization. Indeed, CMR provides critical insights into myocardial oedema, necrosis, and fibrosis, which are essential for confirming the diagnosis, stratifying prognosis, and guiding therapy. Parametric mapping techniques allow for highly accurate detection of myocardial fibrosis (native T1 mapping) and inflammation (T2 mapping), even in the absence of gadolinium contrast, making it particularly valuable in paediatric patients. In conclusion, multimodality imaging, integrating echocardiography and CMR, allows for a comprehensive understanding of disease severity, guiding treatment decisions and optimizing long-term outcomes. This review underscores the importance of a tailored, imaging-driven approach to managing paediatric myocarditis, ensuring the best possible care for this special population.

Few studies have investigated the differential effects of targeted temperature management (TTM) according to the severity of the condition in pediatric patients with post-cardiac arrest syndrome (PCAS). This study was aimed at evaluating the differential effects of TTM in pediatric patients with PCAS according to a risk classification tool developed by us, the rCAST.

We used data from a nationwide prospective registry for out-of-hospital cardiac arrest (OHCA) patients in Japan. We classified eligible pediatric PCAS patients (aged ≤ 18 years) into quintiles based on their rCAST scores and evaluated the effect of TTM on the neurological outcomes in each severity group. Then, focusing on the severity group that appeared to benefit from TTM, we also evaluated the effect of TTM by propensity score analysis. Good neurological outcome was defined as a score on the Cerebral Performance Category or Pediatric Cerebral Performance Category scale of ≤2 at 30 days.

Among 1526 OHCA pediatric patients enrolled in the registry, the data of 307 PCAS patients were analyzed. None of the patients in the fifth quintile (rCAST ≥ 18.5) showed a good neurological outcome, regardless of whether they received TTM or not (0% [0/20] vs. 0% [0/73]). The propensity score analysis showed that TTM was significantly associated with a good neurological outcome in patients with rCAST scores in the first to fourth quintile (odds ratio: 1.21 [1.04-1.40], p = 0.014).

TTM was significantly associated with good neurological outcomes in pediatric PCAS patients with rCAST scores of ≤18.0.

Capillary refill time (CRT) is a valuable clinical sign in pediatric assessment, particularly in evaluating circulatory status. We present a case of a one-month-old infant with supraventricular tachycardia (SVT), who demonstrated prolonged CRT, emphasizing the importance of this physical examination finding in the context of other signs of compromised circulation.

Background: This study aimed to assess the feasibility and quality of resuscitation maneuvers performed on a newborn over the mother's body while maintaining SSC and delayed cord clamping. Methods: A randomized crossover manikin study compared standard cardiopulmonary resuscitation (Std-CPR) and cardiopulmonary resuscitation during SSC (SSC-CPR). Nursing students (n = 40) were recruited and trained in neonatal CPR. The quality of the CPR, including compression and ventilation variables, was evaluated using Laerdal Resusci Baby QCPR® manikins. Findings: No significant differences were found in the compression variables between the Std-CPR and the SSC-CPR. The quality variables demonstrated comparable results between the two techniques. The quality of the compressions showed medians of 74% for the Std-CPR and 74% for the SSC-CPR (p = 0.79). Similarly, the quality of the ventilations displayed medians of 94% for the Std-CPR and 96% for the SSC-CPR (p = 0.12). The overall CPR quality exhibited medians of 75% for the Std-CPR and 82% for the SSC-CPR (p = 0.06). Conclusions: Performing CPR on a newborn over the mother's body during SSC is feasible and does not compromise the quality of resuscitation maneuvers. This approach may offer advantages in preserving maternal-newborn bonding and optimizing newborn outcomes. Further studies are needed to address the limitations of this research, including the use of simulations that may not fully replicate real-life conditions, the lack of analysis of different types of labor, and the unpredictability of the maternal response during resuscitation.

Investigate the acute impact of COVID-19 mitigation measures implemented in March 2020 on a comprehensive range of perinatal outcomes.

National registry-based quasi-experimental study.

We obtained data from the Dutch Perinatal Registry (2010-2020) which was linked to multiple population registries containing sociodemographic variables. A difference-in-discontinuity approach was used to examine the impact of COVID-19 mitigation measures on various perinatal outcomes. We investigated preterm birth incidence across onset types, alongside other perinatal outcomes including low birth weight, small-for-gestational-age, NICU admission, low-APGAR-score, perinatal mortality, neonatal death, and stillbirths.

The analysis of the national-level dataset revealed a consistent pattern of reduced preterm births after the enactment of COVID-19 mitigation measures on March 9, 2020 (OR = 0.80, 95% CI 0.68-0.96). A drop in spontaneous preterm births post-implementation was observed (OR = 0.80, 95% CI 0.62-0.98), whereas no change was observed for iatrogenic births. Regarding stillbirths (OR = 0.95, 95% CI 0.46-1.95) our analysis did not find compelling evidence of substantial changes. For the remaining outcomes, no discernible shifts were observed.

Our findings confirm the reduction in preterm births following COVID-19 mitigation measures in the Netherlands. No discernible changes were observed for other outcomes, including stillbirths. Our results challenge previous concerns of a potential increase in stillbirths contributing to the drop in preterm births, suggesting alternative mechanisms.

The influence of various levels of sedation depth on motor evoked potentials (MEP) reproducibility in youth is still unclear because of a lack of data. We tested the hypothesis that a deeper level of total intravenous anesthesia (TIVA) [bispectral index (BIS) 40 ± 5 compared to 60 ± 5] can affect surgeon-directed MEP and their interpretation in youths.

All patients received TIVA combined with propofol and remifentanil. TIVA was initially maintained at a BIS level of 60 ± 5. The sedation anesthesia was deepened to BIS level 40 ± 5 before the skin incision. MEP were recorded and interpreted at both BIS levels. The primary endpoint was to evaluate the effect of the depth of sedation on the MEP reproducibility directed and interpreted by the surgical team in each patient separately. The secondary endpoint was to compare the relativized MEP parameters (amplitude and latency) in percentage at various levels of sedation in each patient separately. We planned to enroll 150 patients. Due to the COVID-19 pandemic, we decided to analyze the results of the first 50 patients.

The surgical team successfully recorded and interpreted MEP in all 50 enrolled patients in both levels of sedation depth without any clinical doubts. The MEP parameters at BIS level 40 ± 5, proportionally compared with the baseline, were latency 104% (97-110%) and the MEP amplitudes 84.5% (51-109%).

Preliminary data predict that deeper sedation (BIS 40 ± 5) does not affect the surgical team's interpretation of MEP in youth patients. These results support that surgeon-directed MEP may be an alternative when neurophysiologists are unavailable.

Current guidelines for parameters of the delivery of chest compressions (CC) for infants and children are largely consensus based. Of the two recommended depth targets - 1.5 inches and 1/3 anterior-posterior chest diameter (APD) - it is unclear whether these have equal potential for injury. In previous experiments, our group showed in an animal model of pediatric asphyxial out-of-hospital cardiac arrest (OHCA; modeling ∼ 7 year-old children) that 1/3 APD resulted in significantly deeper CC and a higher likelihood of life-threatening injury. We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant model of asphyxial OHCA.

Swine were sedated, anesthetized, paralyzed, intubated through direct laryngoscopy, and then mechanically ventilated (10 ml/kg, FiO2:21%). APD was measured and confirmed by two investigators via a sliding T-square at the xiphoid. After instrumentation for vital signs monitoring, and while still anesthetized, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 min. Animals were then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. Advanced life support drugs were administered at 13 min, and defibrillation at 14 min. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 min of failed resuscitation. Survivors were sacrificed with KCl after 20 min of observation. Veterinary staff conducted necropsy to assay lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Injury characteristics were summarized and compared via Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05.

A total of 36 animals were included for analysis (Group 1: 18; Group 2: 18). Mean (SD) APD overall was 5.58 (0.23) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups. No injury characteristics differed significantly between groups.

In an swine model of infant asphyxial OHCA and resuscitation considering 1/3 APD or 1.5 inches, neither CC depth strategy was associated with increased injury.

During resuscitation in emergency situations, establishing intravascular access is crucial for promptly initiating delivery of fluids, blood, blood products, and medications. In cases of emergency, when intravenous (IV) access proves unsuccessful, intraosseous (IO) access serves as a viable alternative. However, there is a notable lack of information concerning the frequency and efficacy of IO access in acute care settings. This study aims to assess the efficacy of intraosseous (IO) access in acute care settings, especially focusing on children in a level 1 trauma center.

This retrospective study included patients with IO access presented in a level 1 trauma center emergency department (ED) between January 2015 and April 2020. Data regarding medication and fluid infusion was documented, and the clinical success rate was calculated.

Of the 109,548 patients that were admitted to the ED, 25,686 IV lines were inserted. Documentation of 188 patients of which 73 (38.8%) children was complete and used for analysis. In these 188 patients, a total of 232 IO accesses were placed. Overall, 182 patients had a functional IO access (204 needles) (88%). In children (age < 18 years) success rate was lower as compared to adults, 71-84% as compared to 94%. However, univariate regression showed no association between the percentage of functional IO access and gender, age, weight, health care location (prehospital and in hospital), anatomical position (tibia as compared to humerus) or type of injury.

Intraosseous access demonstrates a high success rate for infusion, independent of gender, age, weight, anatomical positioning, or healthcare setting, with minimal complication rates. Caution is especially warranted for children under the age of six months, since success rate was lower.

Manual ventilation, most commonly with a bag-valve mask, is a form of short-term ventilation used during resuscitative efforts in emergent and out-of-hospital scenarios. However, compared to mechanical ventilation, manual ventilation is an operator-dependent skill that is less well controlled and is highly subject to providing inappropriate ventilation to the patient. This article first reviews recent manual ventilation guidelines set forth by the American Heart Association and European Resuscitation Council for providing appropriate manual ventilation parameters (e.g., tidal volume and respiratory rate) in different patient populations in the setting of cardiopulmonary resuscitation. There is then a brief review of clinical and manikin-based studies that demonstrate healthcare providers routinely hyperventilate patients during manual ventilation, particularly in emergent scenarios. A discussion of the possible mechanisms of injury that can occur during inappropriate manual hyperventilation follows, including adverse hemodynamic alterations and lung injury such as acute barotrauma, gastric regurgitation and aspiration, and the possibility of a subacute, inflammatory-driven lung injury. Together, these injurious processes are described as manual-ventilation-induced lung injury (MVILI). This review concludes with a discussion that highlights recent progress in techniques and technologies for minimizing manual hyperventilation and MVILI, with a particular emphasis on tidal-volume feedback devices.

Current data are insufficient for the leading resuscitation societies to advise on the use of extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to explore the current utilization of ECPR for pediatric OHCA and characterize the patient demographics, arrest features, and metabolic parameters associated with survival.

Retrospective review of the Extracorporeal Life Support Organization Registry database from January 2020 to May 2023, including children 28 days to 18 years old who received ECPR for OHCA. The primary outcome was survival to hospital discharge.

Eighty patients met inclusion criteria. Median age was 8.8 years [2.0-15.8] and 53.8% of patients were male. OHCA was witnessed for 65.0% of patients and 46.3% received bystander cardiopulmonary resuscitation (CPR). Initial rhythm was shockable in 26.3% of patients and total CPR duration was 78 min [52-106]. Signs of life were noted for 31.3% of patients and a cardiac etiology precipitating event was present in 45.0%. Survival to discharge was 29.9%. Initial shockable rhythm was associated with increased odds of survival (unadjusted OR 4.7 [1.5-14.5]; p = 0.006), as were signs of life prior to ECMO (unadjusted OR 7.8 [2.6-23.4]; p < 0.001). Lactate levels early on-ECMO (unadjusted OR 0.89 [0.79-0.99]; p = 0.02) and at 24 h on-ECMO (unadjusted OR 0.62 [0.42-0.91]; p < 0.001) were associated with decreased odds of survival.

These preliminary data suggest that while overall survival is poor, a carefully selected pediatric OHCA patient may benefit from ECPR. Further studies are needed to understand long-term neurologic outcomes.

Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure.

Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020.

Single-center pediatric department in a German University Hospital.

Imaging data were obtained from 290 patients of 3-16 years old.

None.

We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth.

In this study of thoracic CT scans in children 3-16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults-6 cm limit-may be chosen.

Background/Objectives: Conducting advanced resuscitation requires medical personnel to carry out appropriately coordinated actions. Certain difficulties arise when it becomes necessary to conduct cardiopulmonary resuscitation (CPR) on two patients at the same time. The aim of this paper was to assess the actions of teams participating in emergency medicine championships in tasks related to simultaneous cardiac arrests in two patients. Methods: The study was conducted on the basis of an analysis of assessment cards for tasks carried out during the 'International Winter Championships in Emergency Medicine'. Three-person medical response teams (MRTs), with the support of two people, had the task of conducting advanced resuscitation on an adult and child simultaneously. The tasks were prepared and developed by European Resuscitation Council (ERC) instructors. Results: The study showed that teams used four methods of checking heart rhythm and performing defibrillation during CPR-using paddles only, using paddles and self-adhesive electrodes, using paddles and a three-lead ECG and using two pairs of self-adhesive electrodes. Teams performing cardiopulmonary resuscitation using paddles and a three-lead ECG performed significantly more actions incorrectly than other teams-in part due to the fact that they incorrectly interpreted which patient's heart rhythm was displayed on the defibrillator screen. The effectiveness of the remaining methods was similar for most of the actions. The CPR method using two pairs of electrodes enabled personal safety to be maintained to the significantly highest percentage during defibrillation. Conclusions: The study demonstrated that the need to conduct CPR on two patients at the same time, irrespective of the method used, caused MRT members considerable difficulties in correctly conducting some of the actions. The method of assessing heart rhythm using paddles and a three-lead ECG should not be used. The study showed that the optimal method of CPR in use appears to be the method using two pairs of adhesive electrodes-it provided, among other things, the significantly highest percentage of safely conducted defibrillation.

Recent emergence of airway clearance devices (ACDs) as a treatment alternative for foreign body airway obstructions (FBAO) lacks substantial evidence on efficacy and safety. This study aimed to assess pediatric residents' knowledge and skills in managing a simulated pediatric choking scenario, adhering to recommended protocols, and using LifeVac© and DeCHOKER© ACDs.

Randomized controlled simulation trial, in which 60 pediatric residents from 3 different hospitals (median age 27 [25.0-29.9]; 76.7% female) were asked to solve an unannounced pediatric simulated choking scenario using three interventions to manage (randomized order): 1) following the recommended protocol of the European Resuscitation Council (encouraging to cough or combination of back blows and abdominal thrusts); 2) using LifeVac©; and 3) using DeCHOKER©. A Little Anne QCPR™ manikin (Laerdal Medical) was used. The variable compliance rate (%) was calculated according to the correct/incorrect execution of the steps constituting the proper actions for each test.

Participants demonstrated a correct compliance rate only ranging between 50-75% in following the recommended protocol for managing partial FBAO progressing to severe. Despite unfamiliarity with the ACDs, pediatric residents achieved rates between 75% and 100%, with no significant difference noted between the two devices (p = 0.173). Both scenarios were successfully resolved in under a minute, with LifeVac© demonstrating a significantly shorter response time compared to DeCHOKER© (39.2 [30.4-49.1] vs. 45.1s [33.7-59.2], p = 0.010).

Only a minority of pediatric residents were able to adhere to the recommended FBAO protocol, whereas 70% of them were able to adequately use the ACDs. However, since a significant proportion could not, it seems that ACDs themselves do not address all issues.

Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC.

The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study.

The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly-switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%).

Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly.

The EPICO (Spanish general registry of COVID-19 in children)-SEHOP (Spanish Society of Pediatric Hematology and Oncology) platform gathers data from children with SARS-CoV-2 in Spain, allowing comparison between children with cancer or allogeneic hematopoietic stem cell transplantation (alloHSCT) and those without. The infection is milder in the cancer/alloHSCT group than in children without comorbidities (7.1% vs. 14.7%), except in children with recent alloHSCT (less than 300 days), of which 35.7% experienced severe COVID-19. These data have been shared with the SEHOP members to support treatment and isolation policies akin to those for children without cancer, except for those with recent alloHSCT or additional comorbidities. This highlights the collaborative registries potential in managing pandemic emergencies.

The International Liaison Committee on Resuscitation (ILCOR) performs rigorous scientific evidence evaluation and publishes Consensus on Science with Treatment Recommendations. These evidence-based recommendations are incorporated by ILCOR constituent resuscitation councils to inform regional guidelines, and further translated into training approaches and materials and implemented by laypersons and healthcare providers in- and out-of-hospital. There is variation in council guidelines as a result of the weak strength of evidence and interpretation. In this manuscript, we highlight ten important similarities and differences in regional council pediatric resuscitation guidelines, and further emphasize three differences that identify key knowledge gaps and opportunity for "natural experiments."

To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge.

We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review.

We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively.

Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.