In order to further enhance the capacity of primary healthcare providers to perform neonatal resuscitation, and to reduce the incidence and mortality of asphyxia-related complications, the Subspecialty Group of Neonatology, Society of Pediatrics, Chinese Medical Association, in collaboration with the Editorial Board of the Chinese Journal of Contemporary Pediatrics, organized experts to integrate the latest clinical research advances in neonatal resuscitation. Considering the realities of primary healthcare institutions, this guideline was developed after thorough expert discussion. The guideline addresses nine common issues concerning neonatal resuscitation faced by primary healthcare providers and provides 22 recommendations.
Humans ; Infant, Newborn ; Resuscitation/standards* ; Primary Health Care ; Infant, Newborn, Diseases/diagnosis*

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.
Burns ; therapy ; Cardiac Output ; Consensus ; Fluid Therapy ; Hemodynamics ; Humans ; Monitoring, Physiologic ; methods ; standards ; Resuscitation ; Shock ; therapy

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.
Burns ; therapy ; Cardiac Output ; Consensus ; Fluid Therapy ; Hemodynamics ; Humans ; Monitoring, Physiologic ; methods ; standards ; Resuscitation ; Shock ; therapy

Trauma is a major cause of death, and haemorrhage represents an important target for improving outcomes after severe injury. Volume replacement with crystalloids in resuscitation might become harmful in large amounts because of coagulopathy. A fine balance must be achieved between haemodynamic and haemostatic resuscitation. Permissive hypotension refers to permitting some degree of hypotension in such adult patients in an attempt to attain this fine balance. For patients who require a significant volume of blood product resuscitation, the term 'massive transfusion protocol' (MTP) is used. There is very little data on transfusion protocols for paediatric trauma patients, and children respond to hypovolemic shock in a different physiological manner compared to adults. Hence, concepts such as permissive hypotension may not be appropriate when treating children involved in major trauma. We recently embarked on a plan to streamline the management of blood transfusion in massive bleeding during paediatric trauma, to reduce the logistical problems associated with the transport of blood products from the blood bank to the patient. From this, we evolved a MTP for paediatric major trauma. Nonetheless, further studies will be needed to see if there is indeed improved outcome after MTP in paediatric major trauma as current evidence is extrapolated from adult studies.
Adult ; Blood Coagulation Disorders ; complications ; therapy ; Child ; Clinical Protocols ; Evidence-Based Medicine ; Fluid Therapy ; standards ; Humans ; Injury Severity Score ; Resuscitation ; methods ; Wounds and Injuries ; complications ; therapy

INTRODUCTIONPaediatric sepsis is a global health problem. It is the leading cause of mortality in infants and children worldwide. Appropriate and timely initial management in the first hours, often termed as the "golden hours", has great impact on survival. The aim of this paper is to summarise the current literature and updates on the initial management of paediatric sepsis.

MATERIALS AND METHODSA comprehensive literature search was performed via PubMed using the search terms: 'sepsis', 'septic shock', 'paediatric' and 'early goal-directed therapy'. Original and review articles were identified and selected based on relevance to this review.

RESULTSEarly recognition, prompt fluid resuscitation and timely administration of antibiotics remain key in the resuscitation of the septic child. Use of steroids and tight glycaemic control in this setting remain controversial.

CONCLUSIONThe use of early goal-directed therapy has had significant impact on patient outcomes and protocolised resuscitation of children in septic shock is recommended.

Child ; Humans ; Practice Guidelines as Topic ; Resuscitation ; standards ; Shock, Septic ; therapy

INTRODUCTIONPrompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore.

MATERIALS AND METHODSThis is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied.

RESULTSEighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%).

CONCLUSIONWe found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use.

Aged ; Aged, 80 and over ; Ambulances ; Cardiopulmonary Resuscitation ; standards ; Electric Countershock ; standards ; Emergency Medical Services ; standards ; Female ; Humans ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest ; diagnosis ; therapy ; Retrospective Studies ; Singapore ; Transportation of Patients ; standards

To realize the measurement of the chest compression depth during the administration of manual cardiopulmonary resuscitation, two 3-axis digital accelerometers were applied for chest compression acceleration and environment acceleration acquisition, with one placed in the chest compression sensor pad, and the other placed in the back sensor pad. Then double integration was made for the acceleration-to-depth conversion with both of the accelerations after preprocessing. The method further included integration reset mechanism based on compression force, with the force point of a pre-determined threshold and the maximum force point as the starting point and the ending point of the integration, respectively. Moreover, a software compensation algorithm was implemented to further increase the accuracy of the depth estimation and reliability of the acceleration. The final performance of the compression depth estimation is within +/- 0.6 cm with 95% confidence of a total of 283 compressions. Accurate and real-time estimation of chest compression depth greatly facilitates the control of compression depth for the lifesaver during manual cardiopulmonary resuscitation.
Acceleration ; Cardiopulmonary Resuscitation ; instrumentation ; methods ; Heart Arrest ; therapy ; Heart Massage ; methods ; standards ; Humans ; Pressure ; Thorax

INTRODUCTIONCardiopulmonary resuscitation (CPR) guidelines were revised in 2005 based on new evidence and expert consensus. However, the benefits of the new guidelines remain undetermined and their influence has not been published in Asia. This study aimed to evaluate the impact of implementing the new resuscitation guidelines and identify factors that influence the discharge survival of out-of-hospital cardiac arrest (OHCA) patients in an Asian metropolitan city.

MATERIALS AND METHODSThis was an observational cohort study of all OHCA patients seen by the emergency medical service during the period before (Nov 2003 to Oct 2005) and after (May 2006 to Oct 2008) implementing the new resuscitation guidelines. Detailed clinical information was recorded using the Ustein style template. Statistical analysis was done using X2 test or t-test for univariate analysis and the logistic regression model for multivariate analysis.

RESULTSThere were 463 patients before and 430 patients after the new guidelines who received resuscitation. The rate of recovery of spontaneous circulation (ROSC), survival-to-intensive care unit (ICU) admission, and survival-to-hospital discharge all showed no benefits regarding the new resuscitation guidelines (ROSC: 42% vs 39%, P = 0.32; Survival-to-ICU admission: 33% vs 30%, P = 0.27; survival-to-hospital discharge: 10% vs 7%, P = 0.09). The rate of ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT), rate of witnessed arrest, and rate of bystander CPR were much lower than in Western studies. After multivariate logistic regression, factors related to discharge survival were witnessed arrest and initial rhythm with VF/pulseless VT. The new resuscitation guidelines did not significantly influence the discharge survival.

CONCLUSIONSWe did not observe any improvement in survival after implementing the new guidelines. Independent factors of survival-to-hospital discharge are witnessed arrest and initial rhythm with VF/pulseless VT. Because the rates of VF/pulseless VT and bystander CPR in Asia are low, popularising CPR training programmes and increasing the rate of bystander CPR may be more important for improving OHCA survival rates than frequent guideline changes.

Aged ; Aged, 80 and over ; Cardiopulmonary Resuscitation ; methods ; standards ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitals, University ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest ; mortality ; therapy ; Patient Discharge ; statistics & numerical data ; Practice Guidelines as Topic ; Survival Analysis ; Taiwan ; epidemiology

INTRODUCTIONIntraosseous access is an alternative to conventional intravenous access when access is difficult or impossible in the adult population. The EZ-IO is a novel intraosseous access device designed for use in adults, utilising a powered driver.

MATERIALS AND METHODSA prospective, observational study involving a convenience sample of 25 medical students, physicians and nursing staff recruited as study subjects to secure intraosseous access using the EZIO powered drill device, on a bone model.

RESULTSTwenty-three (92%) of the 25 study subjects required only 1 attempt at placing the EZ-IO. There were 24 (96%) successful placements of the EZ-IO. The average time taken to place the EZ-IO was 13.9 seconds. Twenty (87%) of 23 participants reported easier placement with the EZ-IO than an intravenous cannula. The average time taken for the physicians, nursing staff and medical students was 3.71 (+/- SD 1.70) seconds, 7.88 (+/- SD 4.02) seconds and 33.7 (24.5), respectively. Overall mean difficulty of insertion score (VAS) was 3.1 (+/- SD 1.9).

CONCLUSIONThe intraosseous access device evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department.

Adult ; Catheterization, Peripheral ; instrumentation ; Catheters, Indwelling ; Equipment Design ; Humans ; Infusions, Intraosseous ; instrumentation ; Professional Competence ; standards ; Prospective Studies ; Resuscitation ; methods ; Shock ; therapy