Journal article
Abstract 11594: Initial Energy Dose and Survival to Hospital Discharge for Pediatric In-hospital Cardiac Arrest Due to Pulseless Ventricular Arrhythmia
Circulation (New York, N.Y.), Vol.140(Suppl_1 Suppl 1), pp.A11594-A11594
11/19/2019
DOI: 10.1161/circ.140.suppl_1.11594
Abstract
The American Heart Association (AHA) recommends an initial defibrillation energy dose of 2 J/kg to treat pediatric in-hospital cardiac arrest (IHCA) with initial ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, the optimal energy dose remains unclear.MethodsUsing data from the AHA Get With the Guidelines-Resuscitation®, we identified children ≤12 years with IHCA and an initial arrest rhythm of VF/pVT. Current Pediatric Basic Life Support guidelines recommend weight-based defibrillation for these pre-pubertal children. Primary exposure was energy dose in joules/kilogram (J/kg), calculated by dividing recorded energy (J) by recorded weight (kg). To account for rounding errors, we categorized energy doses as follows1.7-2.5 J/kg as reference (reflecting a 2 J/kg intended energy dose), <1.7 J/kg and >2.5 J/Kg. The latter two categories were combined for sample size considerations. We compared survival for initial energy doses of 1.7-2.5 J/kg to all other doses. We constructed multivariable logistic regression models to test the association of energy dose with survival, adjusting for age, arrest location, illness category, initial rhythm and vasoactive medications.ResultsWe identified 301 patients ≤12 years with index IHCA and initial VF or pVT. 4% of patients ≤12 had energy ≥120 J, the recommended initial adult dose. Survival to hospital discharge was significantly lower when energy doses other than 1.7-2.5 J/kg were used (adjusted odds ratio [aOR] 0.64; 95% confidence interval [CI] 0.44-0.89; p<0.01). Individual dose categories of either <1.7 J/kg (aOR 0.73 95% CI 0.47-1.15; p=0.18) or >2.5 J/kg (aOR 0.55 95% CI 0.29-1.04; p=0.06), were not associated with differences in survival to discharge compared to 1.7-2.5 J/kg. In sensitivity analysis of patients with initial VF (n=170), an initial energy dose >2.5 J/kg was associated with worse survival (aOR 0.44, 95% CI 0.21-0.90; P=0.03), compared to an initial dose of 1.7-2.5 J/kg.ConclusionsInitial energy doses other than 2 J/kg for IHCA presenting with VF/pVT are associated with worse survival to hospital discharge in patients ≤12 years. Results support current AHA guidelines of initial energy dose of 2 J/kg in preadolescent patients and those with initial VF.
Details
- Title: Subtitle
- Abstract 11594: Initial Energy Dose and Survival to Hospital Discharge for Pediatric In-hospital Cardiac Arrest Due to Pulseless Ventricular Arrhythmia
- Creators
- Derek Hoyme - University of Wisconsin–MadisonYunshu Zhou - University of IowaSaket Girotra - University of IowaMarc Berg - Menlo SchoolRobert Berg - Childrens Hosp of Philadelphia, Philadelphia, PASarah Haskell - University of IowaMary Hazinski - Vanderbilt UniversityJavier Lasa - Texas Children’s Hosp, Houston, TXPeter Meaney - Menlo SchoolVinay Nadkarni - Childrens Hosp of Philadelphia, Philadelphia, PARicardo Samson - Pediatrics, Childrens Heart Cntr Nevada, Las Vegas, NVDianne Atkins - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.140(Suppl_1 Suppl 1), pp.A11594-A11594
- Publisher
- by the American College of Cardiology Foundation and the American Heart Association, Inc
- DOI
- 10.1161/circ.140.suppl_1.11594
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/19/2019
- Academic Unit
- Internal Medicine; Cardiovascular Medicine; Stead Family Department of Pediatrics; Critical Care
- Record Identifier
- 9984354399402771
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