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Long society scientific session
Session Type
Long society scientific session
Room
Hall D
Date
18.10.2020, Sunday
Session Time
09:00 - 10:40
Session Description
Pre recorded & live Q&A

Improving outcomes for children with congenital heart disease

Session Type
Long society scientific session
Date
18.10.2020, Sunday
Session Time
09:00 - 10:40
Room
Hall D
Lecture Time
09:00 - 09:20

Goal directed strategies for improving survival in post-resuscitation care?

Session Type
Long society scientific session
Date
18.10.2020, Sunday
Session Time
09:00 - 10:40
Room
Hall D
Lecture Time
09:20 - 09:40

CONTINUOUS AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY DURING NEONATAL AND PEDIATRIC EXTRA CORPOREAL MEMBRANE OXYGENATION.

Session Type
Long society scientific session
Date
18.10.2020, Sunday
Session Time
09:00 - 10:40
Room
Hall D
Lecture Time
09:40 - 09:50

Abstract

Abstract Body

Objective. To describe electrophysiological findings associated with neurological outcome in neonates and children supported with extracorporeal membrane oxygenation (ECMO).

Design. Retrospective review of neonates and children supported with ECMO and monitored with continuous amplitude-integrated electroencephalography (aEEG) in two french PICUs. Electrophysiological activity was assessed using an aEEG background score within the first 24 hours of ECMO, electric seizures were screened during all ECMO run. Neurologic outcome was defined as the Pediatric Cerebral Performance Category (PCPC) score at hospital discharge (favorable neurological outcome: PCPC 1-3; unfavorable neurological outcome: PCPC 4-6). Secondary outcome was the occurrence of seizure and the association between seizure and focal neurological defect diagnosed by imaging.

Results. 75 patients (median age 78 days [8-621], median weight 4.76 kg [3.25-10]) were included. Mean time between instauration of ECMO and aEEG monitoring start was 8.3 ± 12.4 hours and patients were monitored during 82.4 ± 62.7 hours. Electrical seizures occurred during 22 (26.2%) ECMO runs. Fifty-four patients were assigned to favorable neurological outcome (n=32) or unfavorable neurological outcome (n=22) at hospital discharge, after exclusions of non-neurological death, late aEEG onset and multiple runs. Mean aEEG background score was higher among patients with unfavorable neurological outcome (24.2 ± 8.2 vs 11.5 ± 3.8, p<0.005). After adjustment for pre-ECMO cardiac arrest and age by binary logistic regression, 24h aEEG background score was significantly associated with the risk of unfavorable neurological outcome at hospital discharge (OR 1.3, CI95% 1.07-1.6).

Conclusions. Continuous aEEG provides early and accurate neurological prognostication in neonates and children supported with ECMO.

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DEVELOPMENT AND VALIDATION OF ENTRUSTABLE PROFESSIONAL ACTIVITIES FOR DUTCH PICU FELLOWS: A NATIONAL DELPHI STUDY

Session Type
Long society scientific session
Date
18.10.2020, Sunday
Session Time
09:00 - 10:40
Room
Hall D
Lecture Time
09:50 - 10:00

Abstract

Abstract Body

Objective

Using Entrustable Professional Activities (EPAs) as a focus of learner assessment is supported by validity evidence. An EPA is a unit of professional practice requiring proficiency in multiple competencies simultaneously that can be entrusted to a sufficiently competent learner. Taken collectively, a set of EPAs form the curriculum of a specialty training. Currently, no Paediatric Intensive Care Unit (PICU) EPAs have been published. The goal of this study was to develop and validate the content of a set of EPAs for Dutch PICU fellows.

Methods

A multistage methodology was employed incorporating sequential input from task force members, a medical education expert, PICU fellowship program directors, and PICU experts (PICU physicians and fellows) via a modified three-round Delphi study. In the first two rounds, experts rated indispensability and clarity of preliminary EPAs. Round three was used to gain explicit confirmation of suitability to implement the proposed EPAs.

Results

Based on median ratings and content validity index (CVI) analysis for indispensability in the first two rounds, all nine preliminary EPAs covered essential activities of PICU physicians. Based on median ratings and CVI analysis for clarity however, four EPAs needed revision. With 96% agreement on all final EPA descriptions in the third round, a high degree of consensus among experts was reached.

Conclusions

The resulting nine validated PICU EPAs provide a succinct overview of the core tasks of DUtch PICU physicians. These EPAs were created to form the basis of an assessment system for Dutch PICU fellows, grounded in core professional activities.

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THE OUTCOMES OF CHILDREN REFERRED TO A PAEDIATRIC TRANSPORT SERVICE FOLLOWING CARDIAC ARREST

Session Type
Long society scientific session
Date
18.10.2020, Sunday
Session Time
09:00 - 10:40
Room
Hall D
Lecture Time
10:00 - 10:10

Abstract

Abstract Body

Background and aims

Survival from cardiac arrest in children is poor. We reviewed referrals to the largest UK PICM transport team to explore which children referred following cardiac arrest survive transfer to and discharge from PICU.

Methods

One year retrospective review of database (01/06/18 – 01/06/19) for all referrals for ‘cardiac arrest’.

Results

Of 2,379 referrals, 58 were included. At time of referral, 50 (86.2%) had return of spontaneous circulation (ROSC), 8 (13.8%) were in ongoing cardiac arrest.

A transport team was dispatched in 39 (67.2%) cases, 35 of whom had ROSC.

One (2.6%) child died prior to team arrival and seven (17.9%) died while the team was present. Data was available for 22 of the remaining 31 of whom nine (41%) died prior to PICU discharge.

Twenty (51.3%) had equal reactive pupils at time of referral, one (2.6%) had unequal pupils and 11 (25.6%) had unreactive pupils. Only one child with unreactive pupils survived to PICU discharge who was transferred to a hospice for end of life care.

No child with an initial cardiac arrest >30 minutes survived to PICU discharge. Of the children referred in an ongoing cardiac arrest three survived transfer to PICU and two survived to PICU discharge.

There was a trend towards a lower lactate in children who survived transfer (mean 11.14 vs 13.17) and discharge from PICU (mean 9.13 vs 13.63).

Conclusions

Unreactive pupils and initial arrest duration of >30 minutes suggest poor prognosis and should lead to consideration of transfer purpose.

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