Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2â¯Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia.
Resuscitation
; 153: 88-96, 2020 08.
Article
en En
| MEDLINE
| ID: mdl-32522702
ABSTRACT
The American Heart Association (AHA) recommends first defibrillation energy dose of 2â¯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 1.7-2.5â¯J/kg as reference (reflecting 2â¯J/kg intended dose), <1.7â¯J/kg and >2.5â¯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 1.7-2.5â¯J/kg. Individual dose categories of <1.7â¯J/kg or >2.5â¯J/kg were not associated with differences in survival. For patients with initial VF, doses >2.5â¯J/kg had worse survival compared to reference. For all patients ≤18 years (nâ¯=â¯422), there were no differences in survival between dosing categories. However, all ≤18 with initial VF receiving >2.5â¯J/kg had worse survival.CONCLUSIONS:
First energy doses other than 1.7-2.5â¯J/kg are associated with lower rate of survival to hospital discharge in patients ≤12 years old with initial VF/pVT, and first doses >2.5â¯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 2â¯J/kg.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Reanimación Cardiopulmonar
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Paro Cardíaco
Límite:
Adolescent
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Child
/
Humans
Idioma:
En
Revista:
Resuscitation
Año:
2020
Tipo del documento:
Article