Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2?Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia.

Hoyme DB, Zhou Y, Girotra S, Haskell SE, Samson RA, Meaney P, Berg M, Nadkarni VM, Berg RA, Hazinski MF, Lasa JJ, Atkins DL. 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 Aug 1; 153:88-96.

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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.