Resuscitation of a Pediatric Drowning in Hypothermic Cardiac Arrest.

The prognosis of pediatric patients who require prolonged resuscitation after ice water drowning and hypothermic cardiac arrest remains guarded. We report a case of successful prolonged resuscitation of a pediatric patient in hypothermic cardiac arrest who showed severe metabolic derangements and went on to make a rapid and full neurologic recovery without the use of extracoproreal rewarming or mechanical cardiac support. Many ground and air medical emergency medical service programs have policies against interfacility transfer of patients in hypothermic cardiac arrest, calling into question the need to revise current protocols.

National survey of bedside ultrasound use in pediatric critical care.

OBJECTIVES: The use of bedside ultrasound in critically ill adults has become standard practice. The current state of bedside ultrasound use in pediatric critical illness is unknown. The purpose of this study was to describe the use of bedside ultrasound in critically ill children with an emphasis on its use for establishing central vascular access. We also sought to describe current methods of training for bedside ultrasound use in pediatric critical care. DESIGN: We conducted a cross-sectional survey on the use of bedside ultrasound in pediatric intensive care units in the United States. MEASUREMENTS AND MAIN RESULTS: Pediatric critical care medical directors or their representatives from 128 of 230 eligible hospitals responded (56% response rate). The use of bedside ultrasound for vascular access was statistically more likely in units with >12 beds, >1,000 yearly admissions, and those with an active fellowship or pediatric cardiothoracic surgery program. Ultrasound was used at least once for vascular access in 82% (105 of 128) of responders, with 86% (90 of 105) using it on a regular basis. When using bedside ultrasound for vascular access, the preferred site is the internal jugular vein. A significant portion of responders use bedside ultrasound for nonvascular procedures such as assessing pleural or pericardial effusions. Despite the widespread use of bedside ultrasound, formal training is rare, occurring in only 20% (18 of 90) of current institutions that utilize bedside ultrasound. CONCLUSIONS: This national survey of the use of bedside ultrasound in pediatric critical care reveals widespread use of the technology. When using bedside ultrasound for vascular access, the preferred site is the internal jugular vein. Despite widespread use of bedside ultrasound, formal training that occurs routinely in other subspecialties is lacking. This survey provides meaningful demographic data that can be useful in planning future prospective studies and implementing formal training in bedside ultrasound for pediatric critical care fellows.