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Outcomes of in-hospital ventricular fibrillation in children
Ricardo A Samson1, Vinay M Nadkarni, Peter A Meaney
1Steele Children's Research Center, University of Arizona, Tucson 85724-5073, USA.
Insights
Pediatric cardiac arrest survival is higher when ventricular fibrillation or tachycardia is the initial rhythm. Outcomes worsen significantly if these tachyarrhythmias develop during CPR, compared to asystole.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Resuscitation Science
Background:
- Ventricular fibrillation (VF) and ventricular tachycardia (VT) are less frequent causes of pediatric cardiac arrest than in adults.
- These tachyarrhythmias may arise during cardiopulmonary resuscitation (CPR) as reperfusion arrhythmias.
- The study investigates whether the timing of VF/VT onset impacts survival in pediatric in-hospital cardiac arrest.
Purpose of the Study:
- To compare survival outcomes for pediatric patients with in-hospital cardiac arrest based on the timing of ventricular fibrillation or tachycardia.
- To determine if initial VF/VT is associated with better outcomes than VF/VT developing during CPR.
- To evaluate the impact of VF/VT onset on survival compared to other pulseless rhythms.
Main Methods:
- Analysis of a large, multicenter, in-hospital cardiac arrest registry for patients under 18 years of age.
- Comparison of outcomes among three groups: initial VF/VT, VF/VT developing during CPR, and no VF/VT.
- Statistical analysis using chi-square and multivariable logistic regression.
Main Results:
- Of 1005 pediatric cardiac arrests, 27% had documented VF/VT.
- 35% survival to discharge for initial VF/VT vs. 11% for subsequent VF/VT (OR 2.6).
- 27% survival for no VF/VT vs. 11% for subsequent VF/VT (OR 3.8).
Conclusions:
- Initial ventricular fibrillation or tachycardia in pediatric in-hospital cardiac arrest is associated with the highest survival rates.
- Outcomes for subsequent ventricular fibrillation or tachycardia are significantly worse than for asystole or pulseless electrical activity.
- The timing of tachyarrhythmia onset is a critical factor influencing survival in pediatric cardiac arrest.
Background:
Ventricular fibrillation and ventricular tachycardia are less common causes of cardiac arrest in children than in adults. These tachyarrhythmias can also begin during cardiopulmonary resuscitation (CPR), presumably as reperfusion arrhythmias. We determined whether the outcome is better for initial than for subsequent ventricular fibrillation or tachycardia.
Methods:
All cardiac arrests in persons under 18 years of age were identified from a large, multicenter, in-hospital cardiac-arrest registry. The results from children with initial ventricular fibrillation or tachycardia, children in whom ventricular fibrillation or tachycardia developed during CPR, and children with no ventricular fibrillation or tachycardia were compared by chi-square and multivariable logistic-regression analysis.
Results:
Of 1005 index patients with in-hospital cardiac arrest, 272 (27 percent) had documented ventricular fibrillation or tachycardia during the arrest. In 104 patients (10 percent), ventricular fibrillation or tachycardia was the initial pulseless rhythm; in 149 patients (15 percent), it developed during the arrest. The time of initiation of ventricular fibrillation or tachycardia was not documented in 19 patients. Thirty-five percent of patients with initial ventricular fibrillation or tachycardia survived to hospital discharge, as compared with 11 percent of patients with subsequent ventricular fibrillation or tachycardia (odds ratio, 2.6; 95 percent confidence interval, 1.2 to 5.8). Twenty-seven percent of patients with no ventricular fibrillation or tachycardia survived to hospital discharge, as compared with 11 percent of patients with subsequent ventricular fibrillation or tachycardia (odds ratio, 3.8; 95 percent confidence interval, 1.8 to 7.6).
Conclusions:
In pediatric patients with in-hospital cardiac arrests, survival outcomes were highest among patients in whom ventricular fibrillation or tachycardia was present initially than among those in whom it developed subsequently. The outcomes for patients with subsequent ventricular fibrillation or tachycardia were substantially worse than those for patients with asystole or pulseless electrical activity.
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