Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation

Robert A. Berg, Ricardo A Samson, Marc D Berg, Fred W. Chapman, Ronald W. Hilwig, Isabelle Banville, Robert G. Walker, Richard C. Nova, Nathan Anavy, Karl B Kern

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objectives: This study was designed to compare outcome after adult defibrillation dosing versus pediatric dosing in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: Weight-based 2 to 4 J/kg monophasic defibrillation dosing is recommended for children in VF, but impractical for automated external defibrillator (AED) use. Present AEDs can only provide adult shock doses or newly developed attenuated adult doses intended for children. A single escalating energy sequence (50/75/86 J) of attenuated adult-dose biphasic shocks (pediatric dosing) is at least as effective as escalating monophasic weight-based dosing for prolonged VF in piglets, but this approach has not been compared to standard adult biphasic dosing. Methods: Following 7 min of untreated VF, piglets weighing 13 to 26 kg (19 ± 1 kg) received either biphasic 50/75/86 J (pediatric dose) or biphasic 200/300/360 J (adult dose) therapies during simulated prehospital life support. Results: Return of spontaneous circulation was attained in 15 of 16 pediatric-dose piglets and 14 of 16 adult-dose piglets. Four hours postresuscitation, pediatric dosing resulted in fewer elevations of cardiac troponin T (0 of 12 piglets vs. 6 of 11 piglets, p = 0.005) and less depression of left ventricular ejection fraction (p < 0.05). Most importantly, more piglets survived to 24 h with good neurologic scores after pediatric shocks than adult shocks (13 of 16 piglets vs. 4 of 16 piglets, p = 0.004). Conclusions: In this model, pediatric shocks resulted in superior outcome compared with adult shocks. These data suggest that adult defibrillation dosing may be harmful to pediatric patients with VF and support the use of attenuating electrodes with adult biphasic AEDs to defibrillate children.

Original languageEnglish (US)
Pages (from-to)786-789
Number of pages4
JournalJournal of the American College of Cardiology
Volume45
Issue number5
DOIs
StatePublished - Mar 1 2005

Fingerprint

Ventricular Fibrillation
Swine
Pediatrics
Shock
Weights and Measures
Troponin T
Defibrillators
Stroke Volume
Nervous System
Electrodes

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation. / Berg, Robert A.; Samson, Ricardo A; Berg, Marc D; Chapman, Fred W.; Hilwig, Ronald W.; Banville, Isabelle; Walker, Robert G.; Nova, Richard C.; Anavy, Nathan; Kern, Karl B.

In: Journal of the American College of Cardiology, Vol. 45, No. 5, 01.03.2005, p. 786-789.

Research output: Contribution to journalArticle

Berg, Robert A. ; Samson, Ricardo A ; Berg, Marc D ; Chapman, Fred W. ; Hilwig, Ronald W. ; Banville, Isabelle ; Walker, Robert G. ; Nova, Richard C. ; Anavy, Nathan ; Kern, Karl B. / Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation. In: Journal of the American College of Cardiology. 2005 ; Vol. 45, No. 5. pp. 786-789.
@article{5e505c4e5bb34b97ba2e9c53b52c12d5,
title = "Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation",
abstract = "Objectives: This study was designed to compare outcome after adult defibrillation dosing versus pediatric dosing in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: Weight-based 2 to 4 J/kg monophasic defibrillation dosing is recommended for children in VF, but impractical for automated external defibrillator (AED) use. Present AEDs can only provide adult shock doses or newly developed attenuated adult doses intended for children. A single escalating energy sequence (50/75/86 J) of attenuated adult-dose biphasic shocks (pediatric dosing) is at least as effective as escalating monophasic weight-based dosing for prolonged VF in piglets, but this approach has not been compared to standard adult biphasic dosing. Methods: Following 7 min of untreated VF, piglets weighing 13 to 26 kg (19 ± 1 kg) received either biphasic 50/75/86 J (pediatric dose) or biphasic 200/300/360 J (adult dose) therapies during simulated prehospital life support. Results: Return of spontaneous circulation was attained in 15 of 16 pediatric-dose piglets and 14 of 16 adult-dose piglets. Four hours postresuscitation, pediatric dosing resulted in fewer elevations of cardiac troponin T (0 of 12 piglets vs. 6 of 11 piglets, p = 0.005) and less depression of left ventricular ejection fraction (p < 0.05). Most importantly, more piglets survived to 24 h with good neurologic scores after pediatric shocks than adult shocks (13 of 16 piglets vs. 4 of 16 piglets, p = 0.004). Conclusions: In this model, pediatric shocks resulted in superior outcome compared with adult shocks. These data suggest that adult defibrillation dosing may be harmful to pediatric patients with VF and support the use of attenuating electrodes with adult biphasic AEDs to defibrillate children.",
author = "Berg, {Robert A.} and Samson, {Ricardo A} and Berg, {Marc D} and Chapman, {Fred W.} and Hilwig, {Ronald W.} and Isabelle Banville and Walker, {Robert G.} and Nova, {Richard C.} and Nathan Anavy and Kern, {Karl B}",
year = "2005",
month = "3",
day = "1",
doi = "10.1016/j.jacc.2004.11.040",
language = "English (US)",
volume = "45",
pages = "786--789",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation

AU - Berg, Robert A.

AU - Samson, Ricardo A

AU - Berg, Marc D

AU - Chapman, Fred W.

AU - Hilwig, Ronald W.

AU - Banville, Isabelle

AU - Walker, Robert G.

AU - Nova, Richard C.

AU - Anavy, Nathan

AU - Kern, Karl B

PY - 2005/3/1

Y1 - 2005/3/1

N2 - Objectives: This study was designed to compare outcome after adult defibrillation dosing versus pediatric dosing in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: Weight-based 2 to 4 J/kg monophasic defibrillation dosing is recommended for children in VF, but impractical for automated external defibrillator (AED) use. Present AEDs can only provide adult shock doses or newly developed attenuated adult doses intended for children. A single escalating energy sequence (50/75/86 J) of attenuated adult-dose biphasic shocks (pediatric dosing) is at least as effective as escalating monophasic weight-based dosing for prolonged VF in piglets, but this approach has not been compared to standard adult biphasic dosing. Methods: Following 7 min of untreated VF, piglets weighing 13 to 26 kg (19 ± 1 kg) received either biphasic 50/75/86 J (pediatric dose) or biphasic 200/300/360 J (adult dose) therapies during simulated prehospital life support. Results: Return of spontaneous circulation was attained in 15 of 16 pediatric-dose piglets and 14 of 16 adult-dose piglets. Four hours postresuscitation, pediatric dosing resulted in fewer elevations of cardiac troponin T (0 of 12 piglets vs. 6 of 11 piglets, p = 0.005) and less depression of left ventricular ejection fraction (p < 0.05). Most importantly, more piglets survived to 24 h with good neurologic scores after pediatric shocks than adult shocks (13 of 16 piglets vs. 4 of 16 piglets, p = 0.004). Conclusions: In this model, pediatric shocks resulted in superior outcome compared with adult shocks. These data suggest that adult defibrillation dosing may be harmful to pediatric patients with VF and support the use of attenuating electrodes with adult biphasic AEDs to defibrillate children.

AB - Objectives: This study was designed to compare outcome after adult defibrillation dosing versus pediatric dosing in a piglet model of prolonged prehospital ventricular fibrillation (VF). Background: Weight-based 2 to 4 J/kg monophasic defibrillation dosing is recommended for children in VF, but impractical for automated external defibrillator (AED) use. Present AEDs can only provide adult shock doses or newly developed attenuated adult doses intended for children. A single escalating energy sequence (50/75/86 J) of attenuated adult-dose biphasic shocks (pediatric dosing) is at least as effective as escalating monophasic weight-based dosing for prolonged VF in piglets, but this approach has not been compared to standard adult biphasic dosing. Methods: Following 7 min of untreated VF, piglets weighing 13 to 26 kg (19 ± 1 kg) received either biphasic 50/75/86 J (pediatric dose) or biphasic 200/300/360 J (adult dose) therapies during simulated prehospital life support. Results: Return of spontaneous circulation was attained in 15 of 16 pediatric-dose piglets and 14 of 16 adult-dose piglets. Four hours postresuscitation, pediatric dosing resulted in fewer elevations of cardiac troponin T (0 of 12 piglets vs. 6 of 11 piglets, p = 0.005) and less depression of left ventricular ejection fraction (p < 0.05). Most importantly, more piglets survived to 24 h with good neurologic scores after pediatric shocks than adult shocks (13 of 16 piglets vs. 4 of 16 piglets, p = 0.004). Conclusions: In this model, pediatric shocks resulted in superior outcome compared with adult shocks. These data suggest that adult defibrillation dosing may be harmful to pediatric patients with VF and support the use of attenuating electrodes with adult biphasic AEDs to defibrillate children.

UR - http://www.scopus.com/inward/record.url?scp=20044364763&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=20044364763&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2004.11.040

DO - 10.1016/j.jacc.2004.11.040

M3 - Article

VL - 45

SP - 786

EP - 789

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -