Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation

Robert A. Berg, Fred W. Chapman, Marc D Berg, Ronald W. Hilwig, Isabelle Banville, Robert G. Walker, Richard C. Nova, Duane L Sherrill, Karl B Kern

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Abstract

Aim: To compare the safety and efficacy of attenuated adult biphasic shocks with standard monophasic weight-based shocks in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: If attenuated adult shocks are safe and effective for prehospital pediatric VF, automated external defibrillators (AEDs) can be easily adapted for pediatric use. Methods: After 7 min of untreated VF, piglets were randomized to treatment with attenuated adult biphasic shocks or weight-based monophasic shocks. The attenuated adult biphasic group received 200/300/360 J shocks, attenuated by specialized pediatric electrodes to 51/78/81 J and the monophasic weight-based control group received 2/4/4 J/kg shocks. Forty-eight female piglets were studied, 16 in each of three weight categories: 4 kg (neonatal), 14 kg (younger child) and 24 kg (older child). The primary outcome measures of efficacy and safety were 24 h survival with good neurological outcome and post-resuscitation left ventricular ejection fraction (LVEF), respectively. Results: For the 24 kg piglets, attenuated adult biphasic shocks resulted in superior 24 h survival with good neurological outcome (6/8 versus 0/8, P<0.001) and greater LVEF 4 h post-resuscitation (34±4% versus 18±5%, P<0.05). For the 14 and 4 kg piglets, 24 h survival with good neurological outcome occurred in 7/8 versus 5/8 and 7/8 versus 3/8, respectively, and LVEF 4 h post-resuscitation was 30±3% versus 36±6% and 30±3% versus 22±4%, respectively. Conclusions: The escalating attenuated adult biphasic dosage strategy was at least as safe and effective as the standard weight-based monophasic dose over a wide range of weights in this piglet model of prehospital VF. This work supports the concept of using an attenuated adult biphasic dosage in children.

Original languageEnglish (US)
Pages (from-to)189-197
Number of pages9
JournalResuscitation
Volume61
Issue number2
DOIs
StatePublished - May 2004

Fingerprint

Ventricular Fibrillation
Shock
Swine
Pediatrics
Weights and Measures
Resuscitation
Stroke Volume
Safety
Defibrillators
Electrodes
Outcome Assessment (Health Care)
Control Groups

Keywords

  • Cardiac arrest
  • Choque eléctrico
  • Defibrillation
  • Desfibrilação
  • Electric countershock
  • Fibrilação ventricular
  • Heart arrest
  • Pediátrico
  • Pediatric
  • Reanimação
  • Resuscitation
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation. / Berg, Robert A.; Chapman, Fred W.; Berg, Marc D; Hilwig, Ronald W.; Banville, Isabelle; Walker, Robert G.; Nova, Richard C.; Sherrill, Duane L; Kern, Karl B.

In: Resuscitation, Vol. 61, No. 2, 05.2004, p. 189-197.

Research output: Contribution to journalArticle

Berg, Robert A. ; Chapman, Fred W. ; Berg, Marc D ; Hilwig, Ronald W. ; Banville, Isabelle ; Walker, Robert G. ; Nova, Richard C. ; Sherrill, Duane L ; Kern, Karl B. / Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation. In: Resuscitation. 2004 ; Vol. 61, No. 2. pp. 189-197.
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abstract = "Aim: To compare the safety and efficacy of attenuated adult biphasic shocks with standard monophasic weight-based shocks in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: If attenuated adult shocks are safe and effective for prehospital pediatric VF, automated external defibrillators (AEDs) can be easily adapted for pediatric use. Methods: After 7 min of untreated VF, piglets were randomized to treatment with attenuated adult biphasic shocks or weight-based monophasic shocks. The attenuated adult biphasic group received 200/300/360 J shocks, attenuated by specialized pediatric electrodes to 51/78/81 J and the monophasic weight-based control group received 2/4/4 J/kg shocks. Forty-eight female piglets were studied, 16 in each of three weight categories: 4 kg (neonatal), 14 kg (younger child) and 24 kg (older child). The primary outcome measures of efficacy and safety were 24 h survival with good neurological outcome and post-resuscitation left ventricular ejection fraction (LVEF), respectively. Results: For the 24 kg piglets, attenuated adult biphasic shocks resulted in superior 24 h survival with good neurological outcome (6/8 versus 0/8, P<0.001) and greater LVEF 4 h post-resuscitation (34±4{\%} versus 18±5{\%}, P<0.05). For the 14 and 4 kg piglets, 24 h survival with good neurological outcome occurred in 7/8 versus 5/8 and 7/8 versus 3/8, respectively, and LVEF 4 h post-resuscitation was 30±3{\%} versus 36±6{\%} and 30±3{\%} versus 22±4{\%}, respectively. Conclusions: The escalating attenuated adult biphasic dosage strategy was at least as safe and effective as the standard weight-based monophasic dose over a wide range of weights in this piglet model of prehospital VF. This work supports the concept of using an attenuated adult biphasic dosage in children.",
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T1 - Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation

AU - Berg, Robert A.

AU - Chapman, Fred W.

AU - Berg, Marc D

AU - Hilwig, Ronald W.

AU - Banville, Isabelle

AU - Walker, Robert G.

AU - Nova, Richard C.

AU - Sherrill, Duane L

AU - Kern, Karl B

PY - 2004/5

Y1 - 2004/5

N2 - Aim: To compare the safety and efficacy of attenuated adult biphasic shocks with standard monophasic weight-based shocks in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: If attenuated adult shocks are safe and effective for prehospital pediatric VF, automated external defibrillators (AEDs) can be easily adapted for pediatric use. Methods: After 7 min of untreated VF, piglets were randomized to treatment with attenuated adult biphasic shocks or weight-based monophasic shocks. The attenuated adult biphasic group received 200/300/360 J shocks, attenuated by specialized pediatric electrodes to 51/78/81 J and the monophasic weight-based control group received 2/4/4 J/kg shocks. Forty-eight female piglets were studied, 16 in each of three weight categories: 4 kg (neonatal), 14 kg (younger child) and 24 kg (older child). The primary outcome measures of efficacy and safety were 24 h survival with good neurological outcome and post-resuscitation left ventricular ejection fraction (LVEF), respectively. Results: For the 24 kg piglets, attenuated adult biphasic shocks resulted in superior 24 h survival with good neurological outcome (6/8 versus 0/8, P<0.001) and greater LVEF 4 h post-resuscitation (34±4% versus 18±5%, P<0.05). For the 14 and 4 kg piglets, 24 h survival with good neurological outcome occurred in 7/8 versus 5/8 and 7/8 versus 3/8, respectively, and LVEF 4 h post-resuscitation was 30±3% versus 36±6% and 30±3% versus 22±4%, respectively. Conclusions: The escalating attenuated adult biphasic dosage strategy was at least as safe and effective as the standard weight-based monophasic dose over a wide range of weights in this piglet model of prehospital VF. This work supports the concept of using an attenuated adult biphasic dosage in children.

AB - Aim: To compare the safety and efficacy of attenuated adult biphasic shocks with standard monophasic weight-based shocks in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: If attenuated adult shocks are safe and effective for prehospital pediatric VF, automated external defibrillators (AEDs) can be easily adapted for pediatric use. Methods: After 7 min of untreated VF, piglets were randomized to treatment with attenuated adult biphasic shocks or weight-based monophasic shocks. The attenuated adult biphasic group received 200/300/360 J shocks, attenuated by specialized pediatric electrodes to 51/78/81 J and the monophasic weight-based control group received 2/4/4 J/kg shocks. Forty-eight female piglets were studied, 16 in each of three weight categories: 4 kg (neonatal), 14 kg (younger child) and 24 kg (older child). The primary outcome measures of efficacy and safety were 24 h survival with good neurological outcome and post-resuscitation left ventricular ejection fraction (LVEF), respectively. Results: For the 24 kg piglets, attenuated adult biphasic shocks resulted in superior 24 h survival with good neurological outcome (6/8 versus 0/8, P<0.001) and greater LVEF 4 h post-resuscitation (34±4% versus 18±5%, P<0.05). For the 14 and 4 kg piglets, 24 h survival with good neurological outcome occurred in 7/8 versus 5/8 and 7/8 versus 3/8, respectively, and LVEF 4 h post-resuscitation was 30±3% versus 36±6% and 30±3% versus 22±4%, respectively. Conclusions: The escalating attenuated adult biphasic dosage strategy was at least as safe and effective as the standard weight-based monophasic dose over a wide range of weights in this piglet model of prehospital VF. This work supports the concept of using an attenuated adult biphasic dosage in children.

KW - Cardiac arrest

KW - Choque eléctrico

KW - Defibrillation

KW - Desfibrilação

KW - Electric countershock

KW - Fibrilação ventricular

KW - Heart arrest

KW - Pediátrico

KW - Pediatric

KW - Reanimação

KW - Resuscitation

KW - Ventricular fibrillation

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U2 - 10.1016/j.resuscitation.2003.12.021

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