Journal article
Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia
Resuscitation, Vol.153, pp.88-96
08/01/2020
DOI: 10.1016/j.resuscitation.2020.05.048
PMID: 32522702
Abstract
The American Heart Association (AHA) recommends first defibrillation energy dose of 2 Joules/kilogram (J/kg) for pediatric cardiac arrest with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, optimal first energy dose remains unclear.
Methods: Using AHA Get With the Guidelines-Resuscitation (R) (GWTG-R) database, we identified children <= 12 years with IHCA due to VF/pVT. Primary exposure was energy dose in J/kg. We categorized energy doses: 1.7-2.5 J/kg as reference (reflecting 2 J/kg intended dose), <1.7 J/kg and >2.5 J/kg. We compared survival for reference doses to all other doses. We constructed models to test association of energy dose with survival; adjusting for age, location, illness category, initial rhythm and vasoactive medications.
Results: We identified 301 patients <= 12 years with index IHCA and initial VF/pVT. Survival to discharge was significantly lower with energy doses other than 1.7-2.5 J/kg. Individual dose categories of <1.7 J/kg or >2.5 J/kg were not associated with differences in survival. For patients with initial VF, doses >2.5 J/kg had worse survival compared to reference. For all patients <= 18 years (n = 422), there were no differences in survival between dosing categories. However, all <= 18 with initial VF receiving >2.5 J/kg had worse survival.
Conclusions: First energy doses other than 1.7-2.5 J/kg are associated with lower rate of survival to hospital discharge in patients <= 12 years old with initial VF/pVT, and first doses >2.5 J/kg had lower survival rates in all patients <= 18 years old with initial VF. These results support current AHA guidelines for first pediatric defibrillation energy dose of 2 J/kg.
Details
- Title: Subtitle
- Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia
- Creators
- Derek B. Hoyme - University of Wisconsin–MadisonYunshu Zhou - Visual SciencesSaket Girotra - Roy J. and Lucille A. Carver College of MedicineSarah E. Haskell - Roy J. and Lucille A. Carver College of MedicineRicardo A. Samson - Children's Heart Center NevadaPeter Meaney - Stanford UniversityMarc Berg - Stanford UniversityVinay M. Nadkarni - Children's Hospital of PhiladelphiaRobert A. Berg - Children's Hospital of PhiladelphiaMary Fran Hazinski - Vanderbilt UniversityJavier J. Lasa - Baylor College of MedicineDianne L. Atkins - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Resuscitation, Vol.153, pp.88-96
- Publisher
- Elsevier
- DOI
- 10.1016/j.resuscitation.2020.05.048
- PMID
- 32522702
- ISSN
- 0300-9572
- eISSN
- 1873-1570
- Number of pages
- 9
- Language
- English
- Date published
- 08/01/2020
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984353928702771
Metrics
9 Record Views