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.
Keywords
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Article info
Publication history
Published online: June 06, 2020
Accepted:
May 26,
2020
Received in revised form:
May 18,
2020
Received:
January 12,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
