Cardiopulmonary Resuscitation in Hospitalized Children With Cardiovascular Disease: Estimated Prevalence and Outcomes From the Kids’ Inpatient Database.
Cardiopulmonary Resuscitation in Hospitalized Children With Cardiovascular Disease: Estimated Prevalence and Outcomes From the Kids’ Inpatient Database.
Pediatr Crit Care Med. 2013 Mar; 14(3): 248-255
Lowry AW, Knudson JD, Cabrera AG, Graves DE, Morales DL, Rossano JW
OBJECTIVE:: Hospitalized children with cardiovascular disease may be at increased risk of cardiac arrest; however, little data exist regarding prevalence, risk factors, or outcomes of cardiopulmonary resuscitation in these patients. We sought to characterize national estimates of cardiopulmonary resuscitation and death after cardiopulmonary resuscitation for hospitalized children with cardiovascular disease. SETTING:: A total of 3,739 hospitals in 38 states participating in Kids’ Inpatient Database. DESIGN:: Retrospective analysis of the 2000, 2003, and 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database was performed. Sample weighting was employed to produce national estimates. MEASUREMENTS AND MAIN RESULTS:: Cardiovascular disease was identified in 2.2% of the estimated 22,175,468 (95% confidence interval 21,391,343-22,959,592) hospitalizations. Cardiopulmonary resuscitation occurred in 0.74% (3,698; 95% confidence interval 3,205-4,191) of hospitalizations of children with cardiovascular disease, compared with 0.05% (11,726; 95% confidence interval 10,647-12,805) without cardiovascular disease (odds ratio 13.8, 95% confidence interval 12.8-15.0). The highest frequency of cardiopulmonary resuscitation occurred with myocarditis (3.0% of admissions), heart failure (2.0%), and coronary pathology (2.0%). Compared with other forms of cardiovascular disease identified in this study, single-ventricle patients were the only subgroup who exhibited a higher mortality after cardiopulmonary resuscitation (mortality 65% vs. 55%; odds ratio 1.7 [95% confidence interval 1.2-2.6]), while those who had undergone cardiac surgery exhibited a lower mortality rate (mortality 48% vs. 57%; odds ratio 0.6 [95% confidence interval 0.5-0.8]). CONCLUSIONS:: Cardiopulmonary resuscitation occurs in approximately 7 per 1,000 hospitalizations of children with cardiovascular disease, a rate greater than ten-fold that observed in hospitalizations of children without cardiovascular disease. Single-ventricle patients demonstrated increased mortality after cardiopulmonary resuscitation, while recent cardiac surgery was associated with a reduced odds of death after cardiopulmonary resuscitation. Further studies are needed to confirm these findings and develop techniques to prevent cardiac arrest in this high-risk population. HubMed – rehab
Mu-rhythm changes during the planning of motor and motor imagery actions.
Neuropsychologia. 2013 Feb 22;
Llanos C, Rodriguez M, Rodriguez-Sabate C, Morales I, Sabate M
Motor imagery is a mental representation of motor behavior which has been widely used to study the cognitive basis of movement. The assumption that real movements and motor imagery (virtual movements) use the same neurobiological basis has been questioned by functional magnetic resonance data. The functional similarity in the planning of real and virtual movements was studied here by analysing event-related EEG recordings of the Mu-activity in the sensitive-motor cortex, pre-motor cortex and supplementary motor cortex. A visual stimulus (an arrow) which displayed the information needed for planning a motion (which can be executed or imaged later after the display of a second stimulus) induced a short-lasting phase-locked Mu-response (PLr) which was wider and more widespread when it was used for the motor planning of real or virtual movements than when it was passively watched. The phase-locked Mu-response was accompanied by a persistent decrease of the Mu-rhythms which were not phase-locked to stimuli (NPLr), a response which also was more marked and generalized when stimuli were used for motor planning than when they were passively observed. PLr and NPLr were similar during motor testing and imagery testing, suggesting that both tasks activated the Mu rhythms to a similar degree. This congruency between real and virtual movements was observed in the three cortical areas studied, where the amplitude, latency and duration of the phase-locked and non-phase-locked Mu response was similar in both cases. These noticeable similarities support the idea that the same cortical mechanisms are recruited during the planning of real and virtual movements, a fact that can be analyzed better when an event-related paradigm and a high time-resolution method are used. HubMed – rehab
Advancing the Science and Practice of Pain Medicine: AAPM 29th Annual Meeting, Fort Lauderdale, FL, April 11-14.
Pain Med. 2013 Mar 5;
Grabois M