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Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia.
Resuscitation. 2020 08; 153:88-96.R

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.

Authors+Show Affiliations

Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Biomedical Sciences, Madison, WI, USA. Electronic address: dhoyme@wisc.edu.Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.Children's Heart Center of Nevada, Department of Pediatrics, University of Nevada-Las Vegas School of Medicine, Las Vegas, NV, USA.Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA.The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA.Vanderbilt University School of Nursing, Nashville, TN, USA.Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32522702

Citation

Hoyme, Derek B., et al. "Improved Survival to Hospital Discharge in Pediatric In-hospital Cardiac Arrest Using 2 Joules/kilogram as First Defibrillation Dose for Initial Pulseless Ventricular Arrhythmia." Resuscitation, vol. 153, 2020, pp. 88-96.
Hoyme DB, Zhou Y, Girotra S, et al. Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia. Resuscitation. 2020;153:88-96.
Hoyme, D. B., Zhou, Y., Girotra, S., Haskell, S. E., Samson, R. A., Meaney, P., Berg, M., Nadkarni, V. M., Berg, R. A., Hazinski, M. F., Lasa, J. J., & Atkins, D. L. (2020). Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia. Resuscitation, 153, 88-96. https://doi.org/10.1016/j.resuscitation.2020.05.048
Hoyme DB, et al. Improved Survival to Hospital Discharge in Pediatric In-hospital Cardiac Arrest Using 2 Joules/kilogram as First Defibrillation Dose for Initial Pulseless Ventricular Arrhythmia. Resuscitation. 2020;153:88-96. PubMed PMID: 32522702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia. AU - Hoyme,Derek B, AU - Zhou,Yunshu, AU - Girotra,Saket, AU - Haskell,Sarah E, AU - Samson,Ricardo A, AU - Meaney,Peter, AU - Berg,Marc, AU - Nadkarni,Vinay M, AU - Berg,Robert A, AU - Hazinski,Mary Fran, AU - Lasa,Javier J, AU - Atkins,Dianne L, Y1 - 2020/06/06/ PY - 2020/01/12/received PY - 2020/05/18/revised PY - 2020/05/26/accepted PY - 2020/6/12/pubmed PY - 2020/6/12/medline PY - 2020/6/12/entrez KW - Arrhythmia KW - Defibrillation KW - Outcomes KW - Pediatric KW - Resuscitation KW - Survival SP - 88 EP - 96 JF - Resuscitation JO - Resuscitation VL - 153 N2 - : 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. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/32522702/Improved_survival_to_hospital_discharge_in_pediatric_in-hospital_cardiac_arrest_using_2_Joules/kilogram_as_first_defibrillation_dose_for_initial_pulseless_ventricular_arrhythmia L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(20)30231-8 DB - PRIME DP - Unbound Medicine ER -
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