UK Paediatric Cardiac Arrest Registries
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1 UK Paediatric Cardiac Arrest Registries Dr Barney Scholefield University of Birmingham, Birmingham Children s Hospital,
2 Overview UK Cardiac Arrest Registries Why create a registry? Challenges & Area to study The best in the world UK OHCA OHCAOutcomes Registry IHCA National Cardiac Arrest Audit Hybrid NET-PACK studies/pedi-resq The Future
3 Disclaimer No financial conflicts of interest UK don t have a perfect registry (yet!)
4 Reasons to have a registry? Understand your population Benchmark Quality improvement
5 Challenges
6 Challenges The Right Data Quality (data & detail) Complete Protected For the Right Patients With the Right Outcomes Survival? Neurological survival? How are they when they grow up?
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8 Areas to study?
9 In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
10 Good Examples?
11 Booth et al Resus 2018 Country Publications No. of records Canary Islands (2008) 0 EuReCa (2007) 0 Germany (2007) 0 Malta (2011) 0 NCAA UK (2009) OHCAO UK (2014) 0 Pan-Asian (2010) 0 USA Arizona (2004) 0 Andalusia (2008) 1 European Peds (2014) French (2011) 1 King County USA (1976) 1 S Korea (2008) 1 Danish (2001) Sweden (1990) 2 Australia VACAR & AUS-ROC (1999 &2014) Japan (2005 & 09) USA CARES (2004) USA GWTG (2010)
12 GWTG-R Prediction models of survival Night and weekend effects Association of intubation during resus High risk groups Use of sodium bicarbonate
13 9 pages 9 pages
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15 In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
16 Out of hospital arrest
17 OHCAO Data collection from NHS Ambulance Service Pre-hospital emergency personnel 70,000 adults in database England (nearly all of it) and Wales Paediatric data not yet fully analysed
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22 In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
23 NET-PACK 1 study (PICANet Post Arrest Care in Kids) PICANet database Jan June 2010 Cardiac arrest patients 0-18yrs: Out of hospital (OHCA) In-hospital (IHCA) Approval for Identifiable Data National Information Governance Board, UK Trent Research Ethics Committee
24 Results
25 Incidence /100'000/year Incidence of OHCA <1 year 1-4 years 5-10 years years 0-15yrs Incidence of OHCA PICU admissions = 1.3 / /year
26 Cause of Cardiac arrest Others 4% OHCA Trauma 24% Not Known 45% Medical 27% Medical = Trauma = Others = respiratory, cardiac, neurological and sepsis traumatic brain injury, burns, drowning and hanging airway obstruction, toxic ingestion
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28 Overall Survival to PICU Discharge OHCA 50% Survived IHCA 76% Survived Died Survived 0 OHCA IHCA
29 Could we improve this registry?
30 PICANET Custom Audit: NETPACK 2
31 NET-PACK study 2 PICNET Prognosis After Cardiac arrest in Kids 2 Prospective audit of post arrest care (OHCA & IHCA) PICANET + Resuscitation variables Pupil reactivity Duration of cardiac arrest Epinephrine dose Shockable rhythm Lactate Outcome: PIC Survival n=400 23/29 PICUs Aug 2014 Dec 2015
32 TTM Evolution ILCOR: International Committee on Resuscitation 33 C > standard better for neurooutcome 2 RCTs in NEJM ILCOR Paeds ILCOR Paeds Should consider C 12-24hrs May be beneficial C 12-24hrs TTM Trial 33 C 36 C No difference in outcome THAPCA-OH C No difference in outcome ILCOR strict control avoid >37.5 C and <32 C?UK
33 Methods Inclusion: Admission to PICU after CA Aged <16yrs CPR 2mins Requiring mechanical ventilation Exclusion: Choice of TTM unrecorded Primary: Reported TTM choice Secondary: Factors associated with survival Hyperthermia event and hospital survival.
34 Survival factors Location of Arrest Shockable Rhythm Cardiac aetiology Duration of CPR Base Deficit Lactate Pupil reactivity All associated with survival
35 In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
36 IHCA National Cardiac Arrest Audit (NCAA) database
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41 In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
42 pedires-q
43 Next upgrade NET-PACK 3 Audit Audit ILCOR 2015 TTM guidance 25 UK & Irish Sites July 2017 Jan 2019 Clinical Prediction Model Neurodevelopmental Outcome after Cardiac arrest
44 Summary Hypothesis generating don t answer all the questions Funding Data, Data, Data Linkage, Ownership, Protection Important
45 @BarneyUoB
Disclosures. Pediatrician Financial: none Volunteer :
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