There’s Hope: Cardiopulmonary Arrest in Children

From Current Opinion in Critical Care:

Purpose of review: To summarize recent advances in pediatric cardiopulmonary arrest prevention, resuscitation and postresuscitation management.

Recent findings: Pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. Data in the 21st century indicate that more than 25% of children treated for in-hospital cardiac arrests survive to hospital discharge and more than 10% of children older than 1 year treated for out-of-hospital cardiac arrests survive to hospital discharge. These data establish that children are more likely to survive to hospital discharge than adults after both in-hospital and out-of-hospital cardiac arrests. Before arrest, exciting new studies demonstrate that the implementation of in-hospital pediatric medical emergency teams is associated with significant decreases in cardiac arrest incidence and overall pediatric hospital mortality. During arrest, ventricular fibrillation or ventricular tachycardia, once thought to be rare in children, occurs during 25% of in-hospital pediatric cardiac arrests and at least 7% of out-of-hospital pediatric cardiac arrests. Survival to hospital discharge is much more likely after arrests with a first documented rhythm of ventricular fibrillation or ventricular tachycardia than after pulseless electric activity and asystole. However, ventricular fibrillation or ventricular tachycardia is not always a favorable rhythm, as survival to discharge is much less likely when ventricular fibrillation or ventricular tachycardia occurs during resuscitation from an arrest with the first documented rhythm of pulseless electric activity or asystole. Further, extracorporeal membrane oxygenation cardiopulmonary resuscitation appears promising under special resuscitation circumstances to improve outcome from highly selected in-hospital pediatric cardiac arrest victims. Further, postresuscitation interventions such as goal-directed therapies and therapeutic hypothermia have been demonstrated in adults and infants to improve outcome for selected cardiac arrest victims and are promising candidate targets for study in children.

Summary: Pediatric cardiac arrest is not a futile condition; many children are successfully resuscitated each year. The implementation of new prearrest, intraarrest and postresuscitative therapies has the potential to further improve survival rates following pediatric cardiac arrest.

Hospitalists Caring for “Boarded” Emergency Department Patients Improves Timeliness of Care

From Medscape (subscription required):

A dedicated hospitalist in the emergency department (ED) to manage the care of admitted patients being “boarded” in the ED reduced length of ED stay and resulted in high rates of discharge and discontinuation of cardiac telemetry monitoring at a large tertiary-care hospital, a new pilot study has found. The results were presented here at Hospital Medicine 2009: Society of Hospital Medicine (SHM) Annual Meeting, during the Innovations session.

“Our roles as hospitalists have expanded. We are no longer confined to the inpatient ward,” said lead author Alan Briones, MD, a hospitalist at Mount Sinai Hospital in New York City.

Like many urban academic medical centers in the United States, Mount Sinai’s ED commonly experiences overcrowding. The most frequent reason is patients admitted to the inpatient medicine service who must stay in the ED for hours, often overnight, while waiting for an inpatient bed, Dr. Briones told the audience. These boarded patients might not receive the care they need, he said, because they are far from the inpatient providers, and the emergency medicine physicians who admitted them to the hospital are busy seeing new patients.

With nearly 80,000 ED visits in 2007 and a mean length of ED stay of more than 10 hours, Mount Sinai sought to improve the problem. The hospital assigned a full-time hospitalist to care for admitted patients boarded in the ED on weekdays from 8 am to 6 pm, when, according to Dr. Briones, boarding was most prevalent.

Iowa governor signs bill expanding kids’ health coverage

From Modern Healthcare:

Iowa Gov. Chet Culver signed into law a nearly $8 million expansion of healthcare he said would ensure that virtually every Iowa child has access to health coverage.

“This will extend health care to literally tens of thousands of Iowa’s uninsured children,” Culver said.

The measure is the third step of a $25 million effort to expand coverage for children of the working poor

Under the measure, the state will spend $5.7 million to offer coverage to children in families making up to three times the federal poverty level. Another $2 million would go toward dental coverage to more than 35,000 children.

Parental Consent

From CNN.com:

A Minnesota judge issued an arrest warrant Tuesday for the mother of Daniel Hauser, a 13-year-old boy who is refusing treatment for his cancer, after neither she nor the boy showed up for a court appearance.

Philip Elbert, Daniel’s court-appointed attorney, said he considers his client to have a “diminished capacity” for reasons of his age and the illness and that he believes Daniel should be treated by a cancer specialist.

Elbert added that he does not believe Daniel — who, according to court papers, cannot read — has enough information to make an informed decision regarding his treatment.

Daniel’s symptoms of persistent cough, fatigue and swollen lymph nodes were diagnosed in January as Hodgkins lymphoma. In February, the cancer responded well to an initial round of chemotherapy, but the treatment’s side effects concerned the boy’s parents, who then opted not to pursue further chemo and instead sought other medical opinions.

Court documents show that the doctors estimated the boy’s chance of 5-year remission with more chemotherapy and possibly radiation at 80 percent to 95 percent.

But the family opted for a holistic medical treatment based upon Native American healing practices called Nemenhah and rejected further treatment.