Jim Tibballs MD
Dr Jim Tibballs, Deputy Director of Intensive Care at the Royal Children's Hospital in Melbourne, was involved in venom research with Prof. Sutherland for many years. His research interests have included the cardiovascular effects of box jellyfish venom, brown snake procoagulants and most recently the clinical effects of the irukandji syndrome. This research was presented at the 6th World Congress of the International Society on Toxinology in Paris, September 2000. He became an honorary senior associate of the Australian Venom Research Unit in 1997. In 1998, he completed his MD in toxinology, and he also has a masters degree in education. With Professor Struan Sutherland he co-authored the second edition of "Australian Animal Toxins” published in 2001.
小児蘇生に関する文献
1. Basic and advanced paediatric cardiopulmonary resuscitation - Guidelines of the Australian and New Zealand Resuscitation Councils 2010.
Tibballs J, Aickin R, Nuthall G; On behalf of the Australian and New Zealand Resuscitation Councils.
J Paediatr Child Health. 2012 Jul;48(7):551-555.
Guidelines for basic and advanced paediatric cardiopulmonary resuscitation (CPR) have been revised by Australian and New Zealand Resuscitation Councils. Changes encourage CPR out-of-hospital and aim to improve the quality of CPR in-hospital. Features of basic CPR include: omission of abdominal thrusts for foreign body airway obstruction; commencement with chest compression followed by ventilation in a ratio of 30:2 or compression-only CPR if the rescuer is unwilling/unable to give expired-air breathing when the victim is 'unresponsive and not breathing normally'. Use of automated external defibrillators is encouraged. Features of advanced CPR include: prevention of cardiac arrest by rapid response systems; restriction of pulse palpation to 10 s to diagnosis cardiac arrest; affirmation of 15:2 compression-ventilation ratio for children and for infants other than newly born; initial bag-mask ventilation before tracheal intubation; a single direct current shock of 4 J/kg for ventricular fibrillation (VF) and pulseless ventricular tachycardia followed by immediate resumption of CPR for 2 min without analysis of cardiac rhythm and avoidance of unnecessary interruption of continuous external cardiac compressions. Monitoring of exhaled carbon dioxide is recommended to detect non-tracheal intubation, assess quality of CPR, and to help match ventilation to reduced cardiac output. The intraosseous route is recommended if immediate intravenous access is impossible. Amiodarone is strongly favoured over lignocaine for refractory VF and adrenaline over atropine for severe bradycardia, asystole and pulseless electrical activity. Family presence at resuscitation is encouraged. Therapeutic hypothermia is acceptable after resuscitation to improve neurological outcome. Extracorporeal circulatory support for in-hospital cardiac arrest may be used in equipped centres.
2. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.
Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D; Pediatric Basic and Advanced Life Support Chapter Collaborators.
Pediatrics. 2010 Nov;126(5):e1261-318.
3. Part 10: Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D; Pediatric Basic and Advanced Life Support Chapter Collaborators.
Circulation. 2010 Oct 19;122(16 Suppl 2):S466-515.
4. External and internal biphasic direct current shock doses for pediatric ventricular fibrillation and pulseless ventricular tachycardia.
Tibballs J, Carter B, Kiraly NJ, Ragg P, Clifford M.
Pediatr Crit Care Med. 2011 Jan;12(1):14-20.
OBJECTIVE:
To determine energy dose and number of biphasic direct current shocks for pediatric ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
DESIGN:
Observation of preshock and postshock rhythms, energy doses, and number of shocks.
SETTING:
Pediatric hospital.
PATIENTS:
Shockable ventricular dysrhythmias.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Forty-eight patients with VF or pulseless VT received external shock at 1.7 ± 0.8 (mean ± SD) J/kg. Return of spontaneous circulation (ROSC) occurred in 23 (48%) patients with 2.0 ± 1.0 J/kg, but 25 (52%) patients remained in VF after 1.5 ± 0.7 J/kg (p = .05). In 24 non-responding patients, additional 1-8 shocks (final dose, 2.8 ± 1.2 J/kg) achieved ROSC in 14 (58%) with 2.6 ± 1.1 J/kg but not in 10 (42%) with 3.2 ± 1.2 J/kg (not significant). Overall, 37 (77%) patients achieved ROSC with 2.2 ± 1.1 J/kg (range, 0.5-5.0 J/kg). Eight patients without ROSC recovered with cardiopulmonary bypass and internal direct current shock. At 13 subsequent episodes of VF or VT among eight patients, five achieved ROSC and survived. In combined first and subsequent resuscitative episodes, doses in the range of 2.5 to < 3 J/kg achieved most cases of ROSC. Survival for > 1 yr was seen in 28 (78%) of 36 patients with VF and seven (58%) of 11 patients with VT, with 35 (73%) overall. Lack of ROSC was associated with multiple shocks (p = .003). Repeated shocks with adhesive pads had significantly less impedance (p < .001). Pads in an anteroposterior position achieved highest ROSC rate. Internal shock for another 48 patients with VF or VT achieved ROSC in 28 (58%) patients with 0.7 ± 0.4 J/kg but not in 20 patients with 0.4 ± 0.3 J/kg (p = .01). Nineteen of the nonresponders who received additional internal 1-9 shocks at 0.6 ± 0.5 J/kg and one patient given extracorporeal membrane oxygenation all recovered, yielding 100% ROSC, but 1-yr survival tallied 43 (90%) patients.
CONCLUSIONS:
The initial biphasic direct current external shock dose of 2 J/kg for VF or pulseless VT is inadequate. Appropriate doses for initial and subsequent shocks seem to be in the range of 3-5 J/kg. Multiple shocks do not favor ROSC. The dose for internal shock is 0.6-0.7 J/kg.
二相性体外式除細動では，初回 > 2 J/kgとし，無効の場合には3-5 J/kgとする。PADは除細動回数を増すごとに，インピーダンスが低下していくが，パドルではもちろんそのようなことはない。体外式除細動の場合には，0.6-0.7 J/kgで施行する。
＜追加文献＞
1. Gutgesell HP, Tacker WA, Geddes LA, et al: Energy dose for ventricular defibrillation of children. Pediatrics 1976; 58:898-901
2. Tibballs J, Kinney S: A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. Resuscitation 2006; 71:310-318
3. Rodriguez-Nunez A, Lopez-Herce J, Garcia C, et al: Pediatric defibrillation after cardiac arrest: Initial response and outcome. Crit Care 2006; 10:R113
4. Rossano JW, Quan L, Kenney MA, et al: Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation. Resuscitation 2006; 70:80-89
5. Berg MD, Samson RA, Meyer RJ, et al: Pediatric defibrillation doses often fail to terminate prolonged out-of-hospital ventricular fibrillation in children. Resuscitation 2005; 67:63-67
6. Gurnett CA, Atkins DL: Successful use of a biphasic waveform automated external defibrillator in a high-risk child. Am J Cardiol 2000; 86:1051-1053
7. Atkins DL, Jorgenson DB: Attenuated pediatric electrode pads for automated external defibrillator use in children. Resuscitation 2005; 66:31-37
8. Konig B, Benger J, Goldsworthy L: Automatic external defibrillation in a 6 year old. Arch Dis Child 2005; 90:310-311
9. Divekar A, Soni R: Successful parental use of an automated external defibrillator for an infant with long-QT syndrome. Pediatrics 2006; 118:e526-e529
10. Berg RA, Chapman FW, Berg MD, et al: Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation. Resuscitation 2004; 61:189-197
11. Berg RA, Samson RA, Berg MD, et al: Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation. J Am Coll Cardiol 2005; 45:786-789
12. Clark CB, Zhang Y, Davies LR, et al: Pediatric transthoracic defibrillation: Biphasic versus monophasic waveforms in an experimental model. Resuscitation 2001; 51:159-163
13. Killingsworth CR, Melnick SB, Chapman FW, et al: Defibrillation threshold and cardiac responses using an external biphasic defibrillator with pediatric and adult adhesive patches in pediatric-sized piglets. Resuscitation 2002; 55:177-185
14. Jacobs IG, Tibballs J, Morley PT, et al: Energy levels for biphasic defibrillation. Med J Aust 2003; 179:451
15. American Heart Association: Part 12: Pediatric Advanced Life Support. Circulation 2005; 112:IV-167-IV-187
16. Australian Resuscitation Council: Resuscitation guideline 12.5. Available at http://www.resus.org. Accessed July 15, 2009
17. Biarent D, Bingham R, Richmond S, et al: European Resuscitation Council Guidelines for resuscitation 2005 Section 6. Paediatric life support. Resuscitation 2005; 67S1:S97-S133
18. Tibballs J, Kinney S: Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 2009; 10:306-312
19. van Alem AP, Chapman FW, Lank P, et al: A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest. Resuscitation 2003; 58:17-24
20. Eftestol T, Sunde K, Steen PA: Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation 2002; 105:2270-2273
21. Edelson D, Abella B, Kramer-Johansen J, et al: Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006; 71:137-145
22. Valenzuela TD, Roe DJ, Nichol G, et al: Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000; 343:1206-1209
23. Chan PS, Krumholz HM, Nichol G, et al: Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 2008; 358:9-17
24. Berg RA, Hilwig RW, Berg MD, et al: Immediate post-shock chest compressions improve outcome from prolonged ventricular fibrillation. Resuscitation 2008; 78:71-76
25. Samson RA, Nadkarni VM, Meaney PA, et al: Outcomes of in-hospital ventricular fibrillation in children. N Eng J Med 2006; 354:2328-2339
26. Samson R, Atkins DL, Kerber RE: Optimal size of self-adhesive preapplied electrode pads in pediatric defibrillation. Am J Cardiol 1995; 75:544-545
27. Nadkarni VM, Larkin GL, Peberdy MA, et al: First documented rhythm and clinical outcomes from in-hospital cardiac arrest among children and adults. JAMA 2006; 295:50-57
28. Perkins GD, Roberts C, Gao F: Delays in defibrillation: influence of different monitoring techniques. Br J Anaesth 2002; 89:405-408
29. Perkins GD, Davies RP, Soar J, et al: The impact of manual defibrillation technique on no-flow time during simulated cardiopulmonary resuscitation. Resuscitation 2007; 73:109-114
30. Garcia LA, Kerber RE: Transthoracic defibrillation: Does electrode adhesive pad position alter transthoracic impedance? Resuscitation 1998; 37:139-143
31. Deakin C, Bennetts S, Petley G, et al: What is the optimal paddle force for paediatric defibrillation. Resuscitation 2002; 55:59
32. Bennetts SH, Deakin CD, Petley GW, Clewlow F: Is optimal paddle force applied during paediatric external defibrillation? Resuscitation 2004; 60:29-32
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