UK Paediatric Cardiac Arrest Registries Dr Barney Scholefield University of Birmingham, Birmingham Children s Hospital, UK @BarneyUoB
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
Disclaimer No financial conflicts of interest UK don t have a perfect registry (yet!)
Reasons to have a registry? Understand your population Benchmark Quality improvement
Challenges
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?
Areas to study?
In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
Good Examples?
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) 0 931 OHCAO UK (2014) 0 Pan-Asian (2010) 0 USA Arizona (2004) 0 Andalusia (2008) 1 European Peds (2014) 1 101 French (2011) 1 King County USA (1976) 1 S Korea (2008) 1 Danish (2001) 2 348 Sweden (1990) 2 Australia VACAR & AUS-ROC (1999 &2014) 4 209 Japan (2005 & 09) 5 514 USA CARES (2004) 12 3900 USA GWTG (2010) 30 3647
GWTG-R Prediction models of survival Night and weekend effects Association of intubation during resus High risk groups Use of sodium bicarbonate
9 pages 9 pages
In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
Out of hospital arrest
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
In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
NET-PACK 1 study (PICANet Post Arrest Care in Kids) PICANet database Jan 2003 - 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
Results
Incidence /100'000/year Incidence of OHCA 2007-2009 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 <1 year 1-4 years 5-10 years 11-15 years 0-15yrs 2.0 1.0 0.0 2007 2008 2009 Incidence of OHCA PICU admissions = 1.3 /100 000/year
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
Overall Survival to PICU Discharge 1000 800 600 400 200 423 418 OHCA 50% Survived 209 653 IHCA 76% Survived Died Survived 0 OHCA IHCA
Could we improve this registry?
PICANET Custom Audit: NETPACK 2
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
TTM Evolution ILCOR: International Committee on Resuscitation 33 C > standard better for neurooutcome 2 RCTs in NEJM 2003 2005 ILCOR Paeds ILCOR Paeds Should consider 32-33 C 12-24hrs May be beneficial 32-33 C 12-24hrs 2010 2013 TTM Trial 33 C 36 C No difference in outcome THAPCA-OH 33.0 36.5 C No difference in outcome 2015 2015 ILCOR strict control avoid >37.5 C and <32 C?UK
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.
Survival factors Location of Arrest Shockable Rhythm Cardiac aetiology Duration of CPR Base Deficit Lactate Pupil reactivity All associated with survival
In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
IHCA National Cardiac Arrest Audit (NCAA) database
In-hospital (ward/ed/theatres) Out of hospital In Neonatal Intensive Care In Paediatric Intensive Care
pedires-q
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
Summary Hypothesis generating don t answer all the questions Funding Data, Data, Data Linkage, Ownership, Protection Important
@BarneyUoB