Publications by authors named "David Hehir"

Background: Resuscitation with chest compressions and positive pressure ventilation in Bidirectional Glenn (BDG) or Fontan physiology may compromise passive venous return and accentuate neurologic injury. We hypothesized that arterial pressure and survival would be better in BDG than Fontan patients.

Methods: Secondary analyses of the Pediatric Intensive Care Quality of CPR and Improving Outcomes from Pediatric Cardiac Arrest databases.

View Article and Find Full Text PDF

Background: Tracheal intubation (TI)-associated cardiac arrest (TI-CA) occurs in 1.7% of pediatric ICU TIs. Our objective was to evaluate resuscitation characteristics and outcomes between cardiac arrest patients with and without TI-CA.

View Article and Find Full Text PDF
Article Synopsis
  • The study focused on pediatric in-hospital CPR events, particularly those involving bradycardia with poor perfusion, to evaluate the effects of early epinephrine on survival outcomes in children.
  • Researchers analyzed data from the ICU-RESUS trial, which involved CPR events that lasted 2 minutes or longer, examining the timing of epinephrine administration and the development of pulselessness.
  • Findings indicated that early epinephrine did not significantly improve the chances of survival or favorable neurological outcomes, while a high percentage of patients experienced pulselessness within the first few minutes of CPR.
View Article and Find Full Text PDF

Adult and pediatric studies provide conflicting data regarding whether post-cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021.

View Article and Find Full Text PDF
Article Synopsis
  • The study investigated the effectiveness of extracorporeal membrane oxygenation (ECPR) for pediatric patients who did not respond to traditional cardiopulmonary resuscitation (CPR) methods, focusing on early hemodynamics and end-tidal carbon dioxide (ET CO2) levels as potential indicators for survival and neurologic outcomes.
  • Data was collected from 97 ECPR patients across 18 ICUs from 2016-2021, revealing that most patients were under one year old and had congenital heart disease; only 41% of patients survived with favorable neurologic outcomes.
  • The study found no significant differences in blood pressure measures or chest compression rates between those who survived
View Article and Find Full Text PDF

Aim: Pediatric cardiopulmonary resuscitation (CPR) guidelines recommend starting CPR for heart rates (HRs) less than 60 beats per minute (bpm) with poor perfusion. Objectives were to (1) compare HRs and arterial blood pressures (BPs) prior to CPR among patients with clinician-reported bradycardia with poor perfusion ("BRADY") vs. pulseless electrical activity (PEA); and (2) determine if hemodynamics prior to CPR are associated with outcomes.

View Article and Find Full Text PDF

Introduction: Though early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge.

View Article and Find Full Text PDF

Objectives: To assess associations between outcome and cardiopulmonary resuscitation (CPR) quality for in-hospital cardiac arrest (IHCA) in children with medical cardiac, surgical cardiac, or noncardiac disease.

Design: Secondary analysis of a multicenter cluster randomized trial, the ICU-RESUScitation Project (NCT02837497, 2016-2021).

Setting: Eighteen PICUs.

View Article and Find Full Text PDF

Aim: To evaluate associations between characteristics of simulated point-of-care cardiopulmonary resuscitation (CPR) training with simulated and actual intensive care unit (ICU) CPR performance, and with outcomes of children after in-hospital cardiac arrest.

Methods: This is a pre-specified secondary analysis of the ICU-RESUScitation Project; a prospective, multicentre cluster randomized interventional trial conducted in 18 ICUs from October 2016-March 2021. Point-of-care bedside simulations with real-time feedback to allow multidisciplinary ICU staff to practice CPR on a portable manikin were performed and quality metrics (rate, depth, release velocity, chest compression fraction) were recorded.

View Article and Find Full Text PDF

Background: Previous studies have identified pulmonary hypertension (PH) as a relatively common diagnosis in children with in-hospital cardiac arrest (IHCA), and preclinical laboratory studies have found poor outcomes and low systemic blood pressures during CPR for PH-associated cardiac arrest. The objective of this study was to determine the prevalence of PH among children with IHCA and the association between PH diagnosis and intra-arrest physiology and survival outcomes.

Methods: This was a prospectively designed secondary analysis of patients enrolled in the ICU-RESUS clinical trial (NCT02837497).

View Article and Find Full Text PDF

Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. Interstage telecardiology visits (TCV) have been effective in identifying clinical concerns and preventing unnecessary emergency department visits in this high-risk population. We aimed to assess the feasibility of implementing auscultation with digital stethoscopes (DSs) during TCV and the potential impact on interstage care in our Infant Single Ventricle Monitoring & Management Program.

View Article and Find Full Text PDF

Background The impact of home monitoring on unanticipated interstage readmissions in infants with hypoplastic left heart syndrome has not been previously studied. We sought to examine the association of our institution's Infant Single Ventricle Management and Monitoring Program (ISVMP) with readmission frequency, cumulative readmission days, and readmission illness severity and to identify patient-level risk factors for readmission. Methods and Results We performed a retrospective single-center cohort study comparing infants with hypoplastic left heart syndrome enrolled in ISVMP (December 2010-December 2019) to historical controls (January 2007-November 2010).

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to assess the effects of calcium administration on outcomes in children experiencing in-hospital cardiac arrest and investigate specific subgroups where calcium might be beneficial.
  • Researchers analyzed data from over 1,100 cardiac arrest cases occurring between 2016 and 2021, focusing on outcomes like return of spontaneous circulation and survival rates post-discharge.
  • Results showed that while calcium use did not improve spontaneous circulation, it correlated with lower survival rates at discharge, especially in children with conditions like sepsis and renal insufficiency.
View Article and Find Full Text PDF

Objectives: Arterial diastolic blood pressure (DBP) greater than 25 mm Hg in infants and greater than 30 mm Hg in children greater than 1 year old during cardiopulmonary resuscitation (CPR) was associated with survival to hospital discharge in one prospective study. We sought to validate these potential hemodynamic targets in a larger multicenter cohort.

Design: Prospective observational study.

View Article and Find Full Text PDF

Objectives: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes.

Design: Multicenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021).

View Article and Find Full Text PDF

Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality; home monitoring programs have mitigated these risks. In 2019, we instituted telemedicine (TM) in our established Infant Single Ventricle Monitoring Program. All consecutive patients discharged following neonatal operation/intervention were monitored until subsequent stage 2 surgical palliation.

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to examine the effects of sodium bicarbonate use on outcomes for children experiencing cardiac arrest in hospitals, specifically looking at survival rates and neurological outcomes.
  • Conducted across 18 pediatric ICUs, the research analyzed data from 1,100 CPR events between October 2016 and March 2021, focusing on characteristics of the patients and outcomes.
  • Results showed that even though sodium bicarbonate was frequently used (48% of cases), it was linked to lower rates of survival to hospital discharge and favorable neurological outcomes, despite having no significant impact on the return of spontaneous circulation (ROSC).
View Article and Find Full Text PDF

Importance: Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes.

Objective: To evaluate the effectiveness of a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings.

View Article and Find Full Text PDF

Objectives: Umbilical venous cannulation is the favored approach to perinatal central access worldwide but has a failure rate of 25-50% and the insertion technique has not evolved in decades. Improving the success of this procedure would have broad implications, particularly where peripherally inserted central catheters are not easily obtained and in neonates with congenital heart disease, in whom umbilical access facilitates administration of inotropes and blood products while sparing vessels essential for later cardiac interventions. We sought to use real-time, point-of-care ultrasound to achieve central umbilical venous access in patients for whom conventional, blind placement techniques had failed.

View Article and Find Full Text PDF

Objectives: In the vast majority of Children's Hospitals, the critically ill patient can be found in one of three locations: the PICU, the neonatal ICU, and the cardiac ICU. Training, certification, and maintenance of certification for neonatology and critical care medicine are over seen by the Accreditation Council for Graduate Medical Education and American Board of Pediatrics. There is no standardization of training or oversight of certification and maintenance of certification for pediatric cardiac critical care.

View Article and Find Full Text PDF

Objectives: Infants with CHD requiring positive pressure ventilation via tracheostomy are especially vulnerable to malnutrition following cardiac surgery. Current post-operative feeding recommendations may overestimate the caloric needs.

Design: We retrospectively studied infants requiring tracheostomy after cardiac surgery.

View Article and Find Full Text PDF