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

23 Scopus citations

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)
Pages (from-to)e16-e23
JournalPediatrics
Volume127
Issue number1
DOIs
StatePublished - Jan 1 2011

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Meaney, P. A., Nadkarni, V. M., Atkins, D. L., Berg, M. D., Samson, R. A., Hazinski, M. F., & Berg, R. A. (2011). Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest. Pediatrics, 127(1), e16-e23. https://doi.org/10.1542/peds.2010-1617