2 research outputs found
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Utility of Brain Injury Biomarkers in Children with Congenital Heart Disease Undergoing Cardiac Surgery
Congenital heart disease (CHD) affects roughly 40,000 children annually. Despite advancements, children undergoing surgery for CHD are at an increased risk for adverse neurological outcomes. Currently, there is no gold standard for the diagnosis of cerebral injury during the perioperative period.
To determine the utility of brain injury biomarkers in children undergoing cardiac surgery.
We searched PUBMED, EMBASE, LILACS, EBSCO, ClinicalTrials.gov, Cochrane Databases, and OVID interface to search MEDLINE through July 2021 and assessed the literature following the snowball method. The search terms used were “congenital heart disease,” “cardiopulmonary bypass,” “biomarkers,” “diagnosis,” “prognosis,” and “children.” No language or publication date restrictions were used. Papers studying inflammatory and imaging biomarkers were excluded. The risk of bias, strengths, and limitations of the study were reported. PROSPERO ID: CRD42021258385.
A total of 1449 articles were retrieved, and 27 were included. Eight neurologic biomarkers were examined. Outcomes assessed included prognosis of poor neurologic outcome, mortality, readmission, and diagnosis of brain injury. Results from these studies support that significant perioperative elevations in brain injury biomarkers in CSF and serum, including S100B, GFAP, NSE, and Activin A, may be diagnostic of real-time brain injury and serve as an independent predictor of adverse neurological outcomes in CHD patients undergoing CPB.
There is limited homogenous data in the field, limiting the generalizability and comparability of the results. Further large-scale longitudinal studies addressing neurological biomarkers in children undergoing CHD corrective surgery are required to support the routine use of neuronal biomarkers in this population
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Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study
Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported.
To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors.
A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected.
Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid.
A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites