Is It Time to Stop Teaching Bystanders Ventilation as Part of Pediatric Cardiopulmonary Resuscitation?
Notice bibliographique
Résumé
he International Liaison Committee on Resuscitation (ILCOR) is made up of the world's major resuscitation councils.Part of its function is to periodically perform systematic reviews of resuscitation topics that are the foundation for council-specific resuscitation guidelines for basic and advanced life support for both adults and children.ILCOR's Pediatric Task Force regularly reviews pediatric resuscitation science to generate evidence-informed treatment recommendations to guide the care of pediatric victims of out-of-hospital cardiac arrest (OHCA). 1 ILCOR's ability to do so has historically been limited by the number and size of the pediatric studies available for its systematic reviews.For more than a decade, the All-Japan Utstein Registry of its Fire and Disaster Management Agency has prospectively collected adult and pediatric OHCA data from across Japan.The registry has an impressive history of accurate and complete data capture, with no missing, incomplete, or inconsistent data for patients included in many of its studies. 2 This registry has allowed observational study of many important clinical questions.Two such questions are addressed in the 2 articles from this registry published in this issue of Circulation: What is the outcome of children with OHCA resuscitated by lay rescuers using chest compression-only cardiopulmonary resuscitation (CC-CPR) compared with conventional CPR (with ventilation) 2 ?And what are the associations between the duration of CPR for pediatric OHCA and patient outcomes.3 Bystander CPR rates in many parts of the world remain low, and the inability or unwillingness to provide ventilation as part of conventional CPR has been one of the often-cited explanations.This, coupled with the greater complexity associated with teaching lay rescuers ventilation and the interruptions to chest compressions to give breaths, has led guidelines and training organizations to encourage CC-CPR by lay rescuers for adult (primarily cardiac-based) OHCA, especially by those rescuers untrained in conventional CPR. 4 To date, outcomes after bystander CC-CPR have been comparable to those after conventional CPR in adults, as supported by data from not only observational studies but also several randomized, controlled trials.5 CC-CPR might be acceptable for use in adults, but what about children?As opposed to the arrhythmic arrests commonly seen in adults, pediatric OHCA is often respiratory in origin, supporting the concept that ventilation may be more critical in pediatric resuscitation.6 ILCOR's 2015 treatment recommendations encouraged rescuers to provide ventilation and chest compressions for pediatric OHCA victims 1 and were based on pooled data from 2 studies from the All-Japan Utstein Registry, showing that the use of CC-CPR compared with conventional CPR was associated with worse 30-day intact neurological survival (risk ratio, 0.46; 95% confidence interval [CI], 0.34-0.62).7,8 Of these 2 studies, the Kitamura study provided more detailed analysis of subgroup outcomes based on the type of cardiac arrest, includ-is it time to Stop teaching Bystanders Ventilation as Part of Pediatric Cardiopulmonary resuscitation?
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,033 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,005 | 0,003 |
| Communication savante | 0,004 | 0,006 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,062 | 0,053 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».