Improving Pediatric Extracorporeal Cardiopulmonary Resuscitation Means Delivering Best Care and Measuring Impact Beyond Survival.
Improving Pediatric Extracorporeal Cardiopulmonary Resuscitation Means Delivering Best Care and Measuring Impact Beyond Survival.
复制标题
改善儿科体外心肺复苏意味着提供最佳护理并衡量生存之外的影响。
DOI：
10.1097/ccm.0000000000003673
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发表时间：
2019
影响因子：
8.8
通讯作者：
MacLaren,Graeme
中科院分区：
文献类型：
--
作者：
Barbaro,RyanP;MacLaren,Graeme
Perhaps surprisingly, both studies also found that the first documented cardiac rhythm was not significantly associated with survival. This contrast with adult studies demonstrating ventricular tachycardia and ventricular fibrillation are associated with improved survival compared with other rhythms (2). However, it is worth noting that Meert et al (3) did find an association between cardiac rhythm and the composite outcome of survival with good neurologic outcome (specifically, survival with Vineland Adaptive Behavior Scale, second edition,≥ 70). Both studies also found that seizures occurred in 12–15% of children after ECPR, but there was no association between seizures and survival.Bembea et al (5) carefully considered the impact of the burden of successive complications on survival, demonstrating that more than two complications were associated with mortality and that the association between complications and mortality increased as the number of complications increased. Neurologic and pulmonary complications carried the greatest risk of death. Technology and electronic health records are increasingly facilitating the generation of large datasets of patient outcomes and care delivery patterns (7). The Food and Drug Administration and the Institute of Medicine (IOM) have advocated that we employ this “real-world” data to inform patient care through learning health systems (8, 9). The IOM defines the learning healthcare system as one “in which progress in science, informatics and care culture align to generate new knowledge as an ongoing, natural byproduct of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and healthcare”(8). Rare but striking examples of pediatric learning health systems exist, such as PEDSnet (10), a national network that aims to facilitate clinical trials, observational research, and quality improvement across rare pediatric diseases. PEDSnet identifies four essential attributes of a learning health system (10):
