| 11 th Annual Pediatric Critical Care Colloquium |
| Session/Time | Patient Care/Sat, 3:00 - 4:00 PM |
| Title | Do Retinal Hemorrhages Occur After CPR in Children? A Prospective, Multi-Institutional Study |
| Author | M Quasney, MD, PhD; N Kerr, MD |
| Affiliation | The Pediatric Critical Care Study Group, Departments of Pediatrics and Ophthalmology, Crippled Children's Foundation Research Center, Le Bonheur Children's Medical Center, U Tennessee |
| Introduction | To determine whether retinal hemorrhages (RH) are found in children following chest compressions in pediatric intensive care units. |
| Design | Prospective mulfi-institufional study |
| Setting | PI CUs of 40 tertiary care hospitals |
| Patients | All children who underwent CPR Darticipating pediatric intensive care units were eligible fo Lne study. Each underwent dilated, direct retinal examination by a pediatric ophthalmologist within 96 hom c)f their arrest. Patients with previous out-of-hospital arrest or with an admission diagnoses of suspected child abuse.1 Lrauma, drowning or seizures were excluded from the study. |
| Interventions | None |
| Measurements | The pabent's age, admission diagnosis, iistory of retinopathy of prematurity, etiology of arrest, length of chest compressions, results of coagulation studies'- platelet counts, and ophthalmologic exam findings were recorded. The number, size, and type of'retinal neMOIThages were recorded. |
| Result | Retinal exams were performed after 11 episodes of CPR. Patients ranged in age f .rom 1-2 nonths (mean = 28 m) with the majority < 12 in.ength of time for chest compressions was 1 1.5 min (range -60 min). All patients were successfully resuscitated.Coagulation studies were performed in 76 episodes; PT and/or PTT were elevated in 67 of these 76 episodes. Platelet counts were- evaluated in 105 episodes-, Larombocytopenia was present in 55 of these 105 episodes.i Small, punctate RH were found after 2 of 112 episodes ol PR. Both patients had thrombocytopeniaand elevated PI and PTT and both were receiving positive pressure 'lation. No retinal hemorrhages were found after CPR venti in patients who had normal coagulation and platelets studies. |
| Conclusion | These reslrlts suggest RH are not found in patients vith normal coagulation and platelet studies after chest compressions and rarelv found in patients with abnormal studies. An ele ated PT or PTT or thrombocvtopenia mav predispose children to RH after chest compressions |
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