Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation

Marc D Berg, Isabelle L. Banville, Fred W. Chapman, Robert G. Walker, Mohammed A. Gaballa, Ronald W. Hilwig, Ricardo A Samson, Karl B Kern, Robert A. Berg

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

The optimal biphasic defibrillation dose for children is unknown. Postresuscitation myocardial dysfunction is common and may be worsened by higher defibrillation doses. Adult-dose automated external defibrillators are commonly available; pediatric doses can be delivered by attenuating the adult defibrillation dose through a pediatric pads/cable system. The objective was to investigate whether unattenuated (adult) dose biphasic defibrillation results in greater postresuscitation myocardial dysfunction and damage than attenuated (pediatric) defibrillation. Design: Laboratory animal experiment. Setting: University animal laboratory. Subjects: Domestic swine weighing 19 ± 3.6 kg. Interventions: Fifty-two piglets were randomized to receive biphasic defibrillation using either adult-dose shocks of 200, 300, and 360 J or pediatric-dose shocks of 50, 75, and 85 J after 7 mins of untreated ventricular fibrillation. Contrast left ventriculograms were obtained at baseline and then at 1, 2, 3, and 4 hrs postresuscitation. Postresuscitation left ventricular ejection fraction and cardiac troponins were evaluated. Measurements and Main Results: By design, piglets in the adult-dose group received shocks with more energy (261 ± 65 J vs. 72 ± 12 J, p < .001) and higher peak current (37 ± 8 A vs. 13 ± 2 A, plt; .001) at the largest defibrillation dose needed. In both groups, left ventricular ejection fraction was reduced significantly at 1, 2, and 4 hrs from baseline and improved during the 4 hrs postresuscitation. The decrease in left ventricular ejection fraction from baseline was greater after adult-dose defibrillation. Plasma cardiac troponin levels were elevated 4 hrs postresuscitation in 11 of 19 adult-dose piglets vs. four of 20 pediatric-dose piglets (p = .02). Conclusions: Unattenuated adult-dose defibrillation results in a greater frequency of myocardial damage and worse postresuscitation myocardial function than pediatric doses in a swine model of prolonged out-of-hospital pediatric ventricular fibrillation cardiac arrest. These data support the use of pediatric attenuating electrodes with adult biphasic automated external defibrillators to defibrillate children. (Pediatr Crit Care Med 2008;9:429 -434).

Original languageEnglish (US)
Pages (from-to)429-434
Number of pages6
JournalPediatric Critical Care Medicine
Volume9
Issue number4
DOIs
StatePublished - Jul 2008

Fingerprint

Ventricular Fibrillation
Swine
Pediatrics
Stroke Volume
Shock
Troponin
Defibrillators
Laboratory Animals
Pediatric Hospitals
Heart Arrest
Electrodes

Keywords

  • Defibrillation
  • Left ventricular ejection fraction
  • Myocardial dysfunction
  • Pediatrics
  • Postresuscitation
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation. / Berg, Marc D; Banville, Isabelle L.; Chapman, Fred W.; Walker, Robert G.; Gaballa, Mohammed A.; Hilwig, Ronald W.; Samson, Ricardo A; Kern, Karl B; Berg, Robert A.

In: Pediatric Critical Care Medicine, Vol. 9, No. 4, 07.2008, p. 429-434.

Research output: Contribution to journalArticle

Berg, Marc D ; Banville, Isabelle L. ; Chapman, Fred W. ; Walker, Robert G. ; Gaballa, Mohammed A. ; Hilwig, Ronald W. ; Samson, Ricardo A ; Kern, Karl B ; Berg, Robert A. / Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation. In: Pediatric Critical Care Medicine. 2008 ; Vol. 9, No. 4. pp. 429-434.
@article{7a387be9a5c14bfab926208650d46196,
title = "Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation",
abstract = "The optimal biphasic defibrillation dose for children is unknown. Postresuscitation myocardial dysfunction is common and may be worsened by higher defibrillation doses. Adult-dose automated external defibrillators are commonly available; pediatric doses can be delivered by attenuating the adult defibrillation dose through a pediatric pads/cable system. The objective was to investigate whether unattenuated (adult) dose biphasic defibrillation results in greater postresuscitation myocardial dysfunction and damage than attenuated (pediatric) defibrillation. Design: Laboratory animal experiment. Setting: University animal laboratory. Subjects: Domestic swine weighing 19 ± 3.6 kg. Interventions: Fifty-two piglets were randomized to receive biphasic defibrillation using either adult-dose shocks of 200, 300, and 360 J or pediatric-dose shocks of 50, 75, and 85 J after 7 mins of untreated ventricular fibrillation. Contrast left ventriculograms were obtained at baseline and then at 1, 2, 3, and 4 hrs postresuscitation. Postresuscitation left ventricular ejection fraction and cardiac troponins were evaluated. Measurements and Main Results: By design, piglets in the adult-dose group received shocks with more energy (261 ± 65 J vs. 72 ± 12 J, p < .001) and higher peak current (37 ± 8 A vs. 13 ± 2 A, plt; .001) at the largest defibrillation dose needed. In both groups, left ventricular ejection fraction was reduced significantly at 1, 2, and 4 hrs from baseline and improved during the 4 hrs postresuscitation. The decrease in left ventricular ejection fraction from baseline was greater after adult-dose defibrillation. Plasma cardiac troponin levels were elevated 4 hrs postresuscitation in 11 of 19 adult-dose piglets vs. four of 20 pediatric-dose piglets (p = .02). Conclusions: Unattenuated adult-dose defibrillation results in a greater frequency of myocardial damage and worse postresuscitation myocardial function than pediatric doses in a swine model of prolonged out-of-hospital pediatric ventricular fibrillation cardiac arrest. These data support the use of pediatric attenuating electrodes with adult biphasic automated external defibrillators to defibrillate children. (Pediatr Crit Care Med 2008;9:429 -434).",
keywords = "Defibrillation, Left ventricular ejection fraction, Myocardial dysfunction, Pediatrics, Postresuscitation, Ventricular fibrillation",
author = "Berg, {Marc D} and Banville, {Isabelle L.} and Chapman, {Fred W.} and Walker, {Robert G.} and Gaballa, {Mohammed A.} and Hilwig, {Ronald W.} and Samson, {Ricardo A} and Kern, {Karl B} and Berg, {Robert A.}",
year = "2008",
month = "7",
doi = "10.1097/PCC.0b013e318172e9f8",
language = "English (US)",
volume = "9",
pages = "429--434",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation

AU - Berg, Marc D

AU - Banville, Isabelle L.

AU - Chapman, Fred W.

AU - Walker, Robert G.

AU - Gaballa, Mohammed A.

AU - Hilwig, Ronald W.

AU - Samson, Ricardo A

AU - Kern, Karl B

AU - Berg, Robert A.

PY - 2008/7

Y1 - 2008/7

N2 - The optimal biphasic defibrillation dose for children is unknown. Postresuscitation myocardial dysfunction is common and may be worsened by higher defibrillation doses. Adult-dose automated external defibrillators are commonly available; pediatric doses can be delivered by attenuating the adult defibrillation dose through a pediatric pads/cable system. The objective was to investigate whether unattenuated (adult) dose biphasic defibrillation results in greater postresuscitation myocardial dysfunction and damage than attenuated (pediatric) defibrillation. Design: Laboratory animal experiment. Setting: University animal laboratory. Subjects: Domestic swine weighing 19 ± 3.6 kg. Interventions: Fifty-two piglets were randomized to receive biphasic defibrillation using either adult-dose shocks of 200, 300, and 360 J or pediatric-dose shocks of 50, 75, and 85 J after 7 mins of untreated ventricular fibrillation. Contrast left ventriculograms were obtained at baseline and then at 1, 2, 3, and 4 hrs postresuscitation. Postresuscitation left ventricular ejection fraction and cardiac troponins were evaluated. Measurements and Main Results: By design, piglets in the adult-dose group received shocks with more energy (261 ± 65 J vs. 72 ± 12 J, p < .001) and higher peak current (37 ± 8 A vs. 13 ± 2 A, plt; .001) at the largest defibrillation dose needed. In both groups, left ventricular ejection fraction was reduced significantly at 1, 2, and 4 hrs from baseline and improved during the 4 hrs postresuscitation. The decrease in left ventricular ejection fraction from baseline was greater after adult-dose defibrillation. Plasma cardiac troponin levels were elevated 4 hrs postresuscitation in 11 of 19 adult-dose piglets vs. four of 20 pediatric-dose piglets (p = .02). Conclusions: Unattenuated adult-dose defibrillation results in a greater frequency of myocardial damage and worse postresuscitation myocardial function than pediatric doses in a swine model of prolonged out-of-hospital pediatric ventricular fibrillation cardiac arrest. These data support the use of pediatric attenuating electrodes with adult biphasic automated external defibrillators to defibrillate children. (Pediatr Crit Care Med 2008;9:429 -434).

AB - The optimal biphasic defibrillation dose for children is unknown. Postresuscitation myocardial dysfunction is common and may be worsened by higher defibrillation doses. Adult-dose automated external defibrillators are commonly available; pediatric doses can be delivered by attenuating the adult defibrillation dose through a pediatric pads/cable system. The objective was to investigate whether unattenuated (adult) dose biphasic defibrillation results in greater postresuscitation myocardial dysfunction and damage than attenuated (pediatric) defibrillation. Design: Laboratory animal experiment. Setting: University animal laboratory. Subjects: Domestic swine weighing 19 ± 3.6 kg. Interventions: Fifty-two piglets were randomized to receive biphasic defibrillation using either adult-dose shocks of 200, 300, and 360 J or pediatric-dose shocks of 50, 75, and 85 J after 7 mins of untreated ventricular fibrillation. Contrast left ventriculograms were obtained at baseline and then at 1, 2, 3, and 4 hrs postresuscitation. Postresuscitation left ventricular ejection fraction and cardiac troponins were evaluated. Measurements and Main Results: By design, piglets in the adult-dose group received shocks with more energy (261 ± 65 J vs. 72 ± 12 J, p < .001) and higher peak current (37 ± 8 A vs. 13 ± 2 A, plt; .001) at the largest defibrillation dose needed. In both groups, left ventricular ejection fraction was reduced significantly at 1, 2, and 4 hrs from baseline and improved during the 4 hrs postresuscitation. The decrease in left ventricular ejection fraction from baseline was greater after adult-dose defibrillation. Plasma cardiac troponin levels were elevated 4 hrs postresuscitation in 11 of 19 adult-dose piglets vs. four of 20 pediatric-dose piglets (p = .02). Conclusions: Unattenuated adult-dose defibrillation results in a greater frequency of myocardial damage and worse postresuscitation myocardial function than pediatric doses in a swine model of prolonged out-of-hospital pediatric ventricular fibrillation cardiac arrest. These data support the use of pediatric attenuating electrodes with adult biphasic automated external defibrillators to defibrillate children. (Pediatr Crit Care Med 2008;9:429 -434).

KW - Defibrillation

KW - Left ventricular ejection fraction

KW - Myocardial dysfunction

KW - Pediatrics

KW - Postresuscitation

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=61749100100&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=61749100100&partnerID=8YFLogxK

U2 - 10.1097/PCC.0b013e318172e9f8

DO - 10.1097/PCC.0b013e318172e9f8

M3 - Article

C2 - 18496405

AN - SCOPUS:61749100100

VL - 9

SP - 429

EP - 434

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 4

ER -