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Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study

Introduction: Patients under palliative home care have special needs for their end-of-life support, which in general does not automatically include cardiopulmonary resuscitation. However, emergency medical services (EMS) respond to emergencies in children under palliative care that lead to cardiopul...

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Autores principales: Schneck, Emmanuel, Janßen, Gisela, Vaillant, Vera, Voelker, Thomas, Dechert, Oliver, Trocan, Laura, Schmitz, Lioba, Rohde, Marius, Sander, Michael, Hauch, Holger
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9872029/
https://www.ncbi.nlm.nih.gov/pubmed/36704133
http://dx.doi.org/10.3389/fped.2022.1105609
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author Schneck, Emmanuel
Janßen, Gisela
Vaillant, Vera
Voelker, Thomas
Dechert, Oliver
Trocan, Laura
Schmitz, Lioba
Rohde, Marius
Sander, Michael
Hauch, Holger
author_facet Schneck, Emmanuel
Janßen, Gisela
Vaillant, Vera
Voelker, Thomas
Dechert, Oliver
Trocan, Laura
Schmitz, Lioba
Rohde, Marius
Sander, Michael
Hauch, Holger
author_sort Schneck, Emmanuel
collection PubMed
description Introduction: Patients under palliative home care have special needs for their end-of-life support, which in general does not automatically include cardiopulmonary resuscitation. However, emergency medical services (EMS) respond to emergencies in children under palliative care that lead to cardiopulmonary resuscitation. To understand the underlying steps of decision-making, this retrospective, cross-sectional, multicenter study aimed to analyze pediatric patients under palliative home care who had been resuscitated. Methods: This study included patients from three spezialized pediatric palliative home care (SHPC) teams. The primary study parameters were the prevalence of cardiopulmonary resuscitation and the decision-making for carrying out pediatric advanced life support (PALS). Further analyses included the causes of cardiac arrest, the type of CPR (basic life support, advanced life support), the patient´s outcome, and involvement of the SHPC in the resuscitation. Descriptive statistical analysis was performed. Results: In total, 880 pediatric patients under palliative home care were included over 8.5 years, of which 17 patients were resuscitated once and two patients twice (overall, 19 events with CPR, 21.6 per 1,000 cases). In 10 of the 19 incidents (52.6%), cardiac arrest occurred suddenly without being predictable. The causes of cardiac arrest varied widely. PALS was performed in 78.9% of the cases by EMS teams. In 12 of 19 events (63.2%) resuscitation was performed on explicit wish of the parents. However, from a medical point of view, only four resuscitation attempts were reasonable. In total 7 of 17 (41.2%) patients survived cardiac arrest with a comparable quality of life. Discussion: Overall, resuscitation attempts were rare events in children under home palliative therapy, but if they occur, EMS are often the primary caregivers. Most resuscitation attempts occurred on explicit wish of the parents independently of the meaningfulness of the medical procedure. Despite the presence of a life-limiting disease, survival with a similar quality was achieved in one third of all resuscitated patients. This study indicates that EMS should be trained for advanced life support in children under home palliative therapy and SHPC should address the scenario of cardiac arrest also in early stages of palliative treatment. These results underline that advance care planning for these children is urgently needed.
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spelling pubmed-98720292023-01-25 Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study Schneck, Emmanuel Janßen, Gisela Vaillant, Vera Voelker, Thomas Dechert, Oliver Trocan, Laura Schmitz, Lioba Rohde, Marius Sander, Michael Hauch, Holger Front Pediatr Pediatrics Introduction: Patients under palliative home care have special needs for their end-of-life support, which in general does not automatically include cardiopulmonary resuscitation. However, emergency medical services (EMS) respond to emergencies in children under palliative care that lead to cardiopulmonary resuscitation. To understand the underlying steps of decision-making, this retrospective, cross-sectional, multicenter study aimed to analyze pediatric patients under palliative home care who had been resuscitated. Methods: This study included patients from three spezialized pediatric palliative home care (SHPC) teams. The primary study parameters were the prevalence of cardiopulmonary resuscitation and the decision-making for carrying out pediatric advanced life support (PALS). Further analyses included the causes of cardiac arrest, the type of CPR (basic life support, advanced life support), the patient´s outcome, and involvement of the SHPC in the resuscitation. Descriptive statistical analysis was performed. Results: In total, 880 pediatric patients under palliative home care were included over 8.5 years, of which 17 patients were resuscitated once and two patients twice (overall, 19 events with CPR, 21.6 per 1,000 cases). In 10 of the 19 incidents (52.6%), cardiac arrest occurred suddenly without being predictable. The causes of cardiac arrest varied widely. PALS was performed in 78.9% of the cases by EMS teams. In 12 of 19 events (63.2%) resuscitation was performed on explicit wish of the parents. However, from a medical point of view, only four resuscitation attempts were reasonable. In total 7 of 17 (41.2%) patients survived cardiac arrest with a comparable quality of life. Discussion: Overall, resuscitation attempts were rare events in children under home palliative therapy, but if they occur, EMS are often the primary caregivers. Most resuscitation attempts occurred on explicit wish of the parents independently of the meaningfulness of the medical procedure. Despite the presence of a life-limiting disease, survival with a similar quality was achieved in one third of all resuscitated patients. This study indicates that EMS should be trained for advanced life support in children under home palliative therapy and SHPC should address the scenario of cardiac arrest also in early stages of palliative treatment. These results underline that advance care planning for these children is urgently needed. Frontiers Media S.A. 2023-01-10 /pmc/articles/PMC9872029/ /pubmed/36704133 http://dx.doi.org/10.3389/fped.2022.1105609 Text en © 2023 Schneck, Janßen, Vaillant, Voelker, Dechert, Trocan, Schmitz, Rohde, Sander and Hauch. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Schneck, Emmanuel
Janßen, Gisela
Vaillant, Vera
Voelker, Thomas
Dechert, Oliver
Trocan, Laura
Schmitz, Lioba
Rohde, Marius
Sander, Michael
Hauch, Holger
Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study
title Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study
title_full Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study
title_fullStr Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study
title_full_unstemmed Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study
title_short Cardiopulmonary resuscitation in pediatric patients under palliative home care – A multicenter retrospective study
title_sort cardiopulmonary resuscitation in pediatric patients under palliative home care – a multicenter retrospective study
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9872029/
https://www.ncbi.nlm.nih.gov/pubmed/36704133
http://dx.doi.org/10.3389/fped.2022.1105609
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