Cardiac arrest in children preceding PICU admission: Aetiology and outcome in a developing country

Includes bibliographical referencesObjective: To describe the characteristics and outcomes of children admitted to PICU following cardiac arrest between January 2010 and December 2011. Methods: Retrospective descriptive study of routinely collected data. Results: Of 2501 PICU admissions, 110 (4.4%; 58.7% male) had preceding cardiac arrest, 80.6% of which occurred in hospital. Median (IQR) age was 7.2 (2.5 - 21.6) months; 30.8% had chronic underlying disease. Children presented most commonly with respiratory (n=28, 27.2%), cardiovascular (n= 22, 21.4%), and gastrointestinal disease (n= 20, 19.4%). Twenty-eight (27.2%) arrested while undergoing a procedure. Cardiopulmonary resuscitation (CPR) was given for median (IQR) 10 (5 - 20) minutes. Thirty-five (34%) patients received no adrenaline, 44 (42.7%) received up to 3 doses of adrenaline, and 24 (23.3%) received more than 3 doses of adrenaline during resuscitation. Duration of CPR and number of adrenaline doses did not significantly influence patient outcome. Survival to PICU discharge was 63 (61.2%), 57 (55.3%) survived to hospital discharge with half the deaths in PICU occurred within 24 hours of PICU admission. Out of 51 survivors whose neurological status were assessed 32 were normal, 6 had mild disability, 7 had moderate disability and 6 had severe disability. Standardized mortality ratio (actual/mean predicted) was 0.7. The median (IQR) length of stay in PICU and hospital were 3 (1 - 8) and 27 (9 -52) days respectively. Pediatric risk of mortality (PIM2) score was the only variable independently associated with mortality on multiple logistic regression (adjusted OR 1.05; 95% CI 1.02 - 1.07; p=0.0009)

Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia.

The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines

Remdesivir for severe covid-19: a clinical practice guideline

What is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the New England Journal of Medicine on 22 May 2020

A living WHO guideline on drugs for covid-19

What is the role of drug interventions in the treatment and prevention of covid-19