Derek B Hoyme1, Yunshu Zhou2, Saket Girotra3, Sarah E Haskell4, Ricardo A Samson5, Peter Meaney6, Marc Berg6, Vinay M Nadkarni7, Robert A Berg7, Mary Fran Hazinski8, Javier J Lasa9, Dianne L Atkins4. 1. Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Biomedical Sciences, Madison, WI, USA. Electronic address: dhoyme@wisc.edu. 2. Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA. 3. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. 4. Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA. 5. Children's Heart Center of Nevada, Department of Pediatrics, University of Nevada-Las Vegas School of Medicine, Las Vegas, NV, USA. 6. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. 7. The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA. 8. Vanderbilt University School of Nursing, Nashville, TN, USA. 9. Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Abstract
The American Heart Association (AHA) recommends first defibrillation energy dose of 2 Joules/kilogram (J/kg) for pediatric cardiac arrest with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, optimal first energy dose remains unclear. METHODS: Using AHA Get With the Guidelines-Resuscitation® (GWTG-R) database, we identified children ≤12 years with IHCA due to VF/pVT. Primary exposure was energy dose in J/kg. We categorized energy doses: 1.7-2.5 J/kg as reference (reflecting 2 J/kg intended dose), <1.7 J/kg and >2.5 J/kg. We compared survival for reference doses to all other doses. We constructed models to test association of energy dose with survival; adjusting for age, location, illness category, initial rhythm and vasoactive medications. RESULTS: We identified 301 patients ≤12 years with index IHCA and initial VF/pVT. Survival to discharge was significantly lower with energy doses other than 1.7-2.5 J/kg. Individual dose categories of <1.7 J/kg or >2.5 J/kg were not associated with differences in survival. For patients with initial VF, doses >2.5 J/kg had worse survival compared to reference. For all patients ≤18 years (n = 422), there were no differences in survival between dosing categories. However, all ≤18 with initial VF receiving >2.5 J/kg had worse survival. CONCLUSIONS: First energy doses other than 1.7-2.5 J/kg are associated with lower rate of survival to hospital discharge in patients ≤12 years old with initial VF/pVT, and first doses >2.5 J/kg had lower survival rates in all patients ≤18 years old with initial VF. These results support current AHA guidelines for first pediatric defibrillation energy dose of 2 J/kg.
The American Heart Association (AHA) recommends first defibrillation energy dose of 2 Joules/kilogram (J/kg) for pediatric cardiac arrest with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, optimal first energy dose remains unclear. METHODS: Using AHA Get With the Guidelines-Resuscitation® (GWTG-R) database, we identified children ≤12 years with IHCA due to VF/pVT. Primary exposure was energy dose in J/kg. We categorized energy doses: 1.7-2.5 J/kg as reference (reflecting 2 J/kg intended dose), <1.7 J/kg and >2.5 J/kg. We compared survival for reference doses to all other doses. We constructed models to test association of energy dose with survival; adjusting for age, location, illness category, initial rhythm and vasoactive medications. RESULTS: We identified 301 patients ≤12 years with index IHCA and initial VF/pVT. Survival to discharge was significantly lower with energy doses other than 1.7-2.5 J/kg. Individual dose categories of <1.7 J/kg or >2.5 J/kg were not associated with differences in survival. For patients with initial VF, doses >2.5 J/kg had worse survival compared to reference. For all patients ≤18 years (n = 422), there were no differences in survival between dosing categories. However, all ≤18 with initial VF receiving >2.5 J/kg had worse survival. CONCLUSIONS: First energy doses other than 1.7-2.5 J/kg are associated with lower rate of survival to hospital discharge in patients ≤12 years old with initial VF/pVT, and first doses >2.5 J/kg had lower survival rates in all patients ≤18 years old with initial VF. These results support current AHA guidelines for first pediatric defibrillation energy dose of 2 J/kg.
Authors: Ian K Maconochie; Richard Aickin; Mary Fran Hazinski; Dianne L Atkins; Robert Bingham; Thomaz Bittencourt Couto; Anne-Marie Guerguerian; Vinay M Nadkarni; Kee-Chong Ng; Gabrielle A Nuthall; Gene Y K Ong; Amelia G Reis; Stephen M Schexnayder; Barnaby R Scholefield; Janice A Tijssen; Jerry P Nolan; Peter T Morley; Patrick Van de Voorde; Arno L Zaritsky; Allan R de Caen Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262