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Pediatric defibrillation after cardiac arrest: initial response and outcome

INTRODUCTION: Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. METHODS: Forty-four out of 241 children (18.2%) who...

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Autores principales: Rodríguez-Núñez, Antonio, López-Herce, Jesús, García, Cristina, Domínguez, Pedro, Carrillo, Angel, Bellón, Jose María
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2006
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751019/
https://www.ncbi.nlm.nih.gov/pubmed/16882339
http://dx.doi.org/10.1186/cc5005
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author Rodríguez-Núñez, Antonio
López-Herce, Jesús
García, Cristina
Domínguez, Pedro
Carrillo, Angel
Bellón, Jose María
author_facet Rodríguez-Núñez, Antonio
López-Herce, Jesús
García, Cristina
Domínguez, Pedro
Carrillo, Angel
Bellón, Jose María
author_sort Rodríguez-Núñez, Antonio
collection PubMed
description INTRODUCTION: Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. METHODS: Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and one-year survival. Characteristics of patients and of resuscitation were evaluated. RESULTS: Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation. CONCLUSION: Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than one-third of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest.
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spelling pubmed-17510192006-12-27 Pediatric defibrillation after cardiac arrest: initial response and outcome Rodríguez-Núñez, Antonio López-Herce, Jesús García, Cristina Domínguez, Pedro Carrillo, Angel Bellón, Jose María Crit Care Research INTRODUCTION: Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. METHODS: Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and one-year survival. Characteristics of patients and of resuscitation were evaluated. RESULTS: Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation. CONCLUSION: Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than one-third of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest. BioMed Central 2006 2006-08-01 /pmc/articles/PMC1751019/ /pubmed/16882339 http://dx.doi.org/10.1186/cc5005 Text en Copyright © 2006 Rodríguez-Núñez et al., licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Rodríguez-Núñez, Antonio
López-Herce, Jesús
García, Cristina
Domínguez, Pedro
Carrillo, Angel
Bellón, Jose María
Pediatric defibrillation after cardiac arrest: initial response and outcome
title Pediatric defibrillation after cardiac arrest: initial response and outcome
title_full Pediatric defibrillation after cardiac arrest: initial response and outcome
title_fullStr Pediatric defibrillation after cardiac arrest: initial response and outcome
title_full_unstemmed Pediatric defibrillation after cardiac arrest: initial response and outcome
title_short Pediatric defibrillation after cardiac arrest: initial response and outcome
title_sort pediatric defibrillation after cardiac arrest: initial response and outcome
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751019/
https://www.ncbi.nlm.nih.gov/pubmed/16882339
http://dx.doi.org/10.1186/cc5005
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