Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest

Peter A. Meaney, Vinay M. Nadkarni, Dianne L. Atkins, Marc D Berg, Ricardo A Samson, Mary Fran Hazinski, Robert A. Berg

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective. PATIENTS AND METHODS: This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤ 18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000-2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose. RESULTS: Of 266 children with 285 events, 173 of 285 (61%) survived the event and 61 of 266 (23%) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53%) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56% vs 91%; P < .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95% confidence interval: 0.21-0.81]) and event survival (odds ratio: 0.42 [95% confidence interval: 0.18-0.98]). CONCLUSIONS: The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.

Original languageEnglish (US)
JournalPediatrics
Volume127
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Pediatric Hospitals
Heart Arrest
Shock
Ventricular Fibrillation
Ventricular Tachycardia
Odds Ratio
Confidence Intervals
Cardiopulmonary Resuscitation
Observational Studies
Registries
Pediatrics

Keywords

  • Cardiac arrest
  • Defibrillation
  • Pediatric
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest. / Meaney, Peter A.; Nadkarni, Vinay M.; Atkins, Dianne L.; Berg, Marc D; Samson, Ricardo A; Hazinski, Mary Fran; Berg, Robert A.

In: Pediatrics, Vol. 127, No. 1, 01.2011.

Research output: Contribution to journalArticle

Meaney, Peter A. ; Nadkarni, Vinay M. ; Atkins, Dianne L. ; Berg, Marc D ; Samson, Ricardo A ; Hazinski, Mary Fran ; Berg, Robert A. / Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest. In: Pediatrics. 2011 ; Vol. 127, No. 1.
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abstract = "OBJECTIVE: To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective. PATIENTS AND METHODS: This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤ 18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000-2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose. RESULTS: Of 266 children with 285 events, 173 of 285 (61{\%}) survived the event and 61 of 266 (23{\%}) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53{\%}) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56{\%} vs 91{\%}; P < .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95{\%} confidence interval: 0.21-0.81]) and event survival (odds ratio: 0.42 [95{\%} confidence interval: 0.18-0.98]). CONCLUSIONS: The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.",
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N2 - OBJECTIVE: To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective. PATIENTS AND METHODS: This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤ 18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000-2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose. RESULTS: Of 266 children with 285 events, 173 of 285 (61%) survived the event and 61 of 266 (23%) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53%) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56% vs 91%; P < .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95% confidence interval: 0.21-0.81]) and event survival (odds ratio: 0.42 [95% confidence interval: 0.18-0.98]). CONCLUSIONS: The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.

AB - OBJECTIVE: To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective. PATIENTS AND METHODS: This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤ 18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000-2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose. RESULTS: Of 266 children with 285 events, 173 of 285 (61%) survived the event and 61 of 266 (23%) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53%) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56% vs 91%; P < .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95% confidence interval: 0.21-0.81]) and event survival (odds ratio: 0.42 [95% confidence interval: 0.18-0.98]). CONCLUSIONS: The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.

KW - Cardiac arrest

KW - Defibrillation

KW - Pediatric

KW - Ventricular fibrillation

KW - Ventricular tachycardia

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