Reducing Cardiac Arrests in the PICU: Initiative to Improve Time to Administration of Prearrest Bolus Epinephrine in Patients With Cardiac Disease.

Objectives: To evaluate the effectiveness of a quality-improvement initiative in reducing cardiac arrests in infants and children in the cardiac ICU.

Design: Prospective observational before-after cohort study.

Setting: Single pediatric cardiac ICU in the United Kingdom.

Monitoring of Antiplatelet Therapy in Children on Ventricular Assist Device Support: Comparison of Multiplate and Thromboelastography Platelet Mapping.

The optimal method for monitoring antiplatelet therapy in children supported with ventricular assist devices (VADs) is unknown. We conducted a retrospective study to compare Thromboelastography Platelet Mapping (TEG/PM) with multiple electrode platelet aggregometry (MEA) on a Multiplate analyzer (Roche Diagnostics, Mannheim, Germany). We analyzed data from 66 paired blood samples from 9 patients <16 years of age on VAD where platelet function was simultaneously measured with TEG/PM and MEA.

The Use of Daptomycin to Treat Methicillin-Resistant Staphylococcus Epidermidis Bacteremia in a Critically Ill Child with Renal Failure.

Daptomycin is excreted primarily unchanged by the kidney. Dosage regimens in children with renal failure remain to be determined. We report the case of an 8-year-old child with multiorgan failure undergoing continuous peritoneal dialysis, successfully treated with intravenous daptomycin for methicillin-resistant Staphylococcus epidermidis bacteremia.

Gastrointestinal complications associated with the surgical treatment of heart disease in children.

Background/purpose: The gastrointestinal system is prone to complications following heart surgery. We sought to determine the incidence and factors associated with gastrointestinal complication after cardiac surgery in children.

Methods: A retrospective review of patients aged <16years that underwent cardiac surgery between 2009 and 2013.

Atrial arrhythmia after transcatheter closure of secundum atrial septal defects in patients ≥40 years of age.

Aim: Data on arrhythmia outcome following device closure of atrial septal defect (ASD) are lacking. This study provides medium-term follow-up data on atrial arrhythmias in patients who were ≥40 years of age at the time of transcatheter ASD closure.

Methods And Results: It is a retrospective review.

Relationship between arterial partial oxygen pressure after resuscitation from cardiac arrest and mortality in children.

Background: Observational studies in adults have shown a worse outcome associated with hyperoxia after resuscitation from cardiac arrest. Extrapolating from adult data, current pediatric resuscitation guidelines recommend avoiding hyperoxia. We investigated the relationship between arterial partial oxygen pressure and survival in patients admitted to the pediatric intensive care unit (PICU) after cardiac arrest.

A spontaneous breathing trial with pressure support overestimates readiness for extubation in children.

Objective: To evaluate the performance of an extubation readiness test based on a spontaneous breathing trial using pressure support.

Design: Retrospective chart review.

Setting: Pediatric intensive care unit.

The temporal relationship between glucose-corrected serum sodium and neurological status in severe diabetic ketoacidosis.

Objective: Cerebral oedema is a potentially devastating complication of diabetic ketoacidosis (DKA). The relationship between osmolar changes, acid-base changes and development of cerebral oedema during therapy is unclear.

Design: Retrospective cohort study on 53 children with severe DKA (mean pH at presentation 6.

Life-threatening organ failure after lamotrigine therapy.

We describe an 11-year-old girl with a seizure disorder who developed fever, rash, rhabdomyolysis, and multiorgan failure 2 weeks after commencing a transition from sodium valproate to lamotrigine therapy. To our knowledge, this patient represents the most severe life-threatening hypersensitivity lamotrigine reaction described in the pediatric literature. We recommend caution when prescribing lamotrigine to children on concomitant sodium valproate, and immediate discontinuation of lamotrigine and the provision of aggressive supportive care in patients with features of lamotrigine hypersensitivity.