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Prehospital countershock treatment of pediatric asystole
J D Losek1, H Hennes, P W Glaeser
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53201.
Insights
Immediate countershock treatment for pulseless nonbreathing pediatric patients with asystole did not improve rhythm change or survival rates. This prehospital intervention prolonged care time without significant benefits, leading to a recommendation against its use in asystolic children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- Prehospital care for pediatric cardiac arrest is critical.
- Asystole is a common initial rhythm in pulseless nonbreathing (PNB) pediatric patients.
- The efficacy of immediate countershock for pediatric asystole in the prehospital setting remains unclear.
Purpose of the Study:
- To evaluate the impact of immediate countershock treatment on rhythm change and resuscitation outcomes in pediatric patients with asystole.
- To analyze factors associated with rhythm change in prehospital pediatric cardiac arrest.
- To determine if countershock treatment affects prehospital care duration.
Main Methods:
- Retrospective review of prehospital care for 117 PNB pediatric patients (0-18 years).
- Comparison of outcomes between asystolic patients who received immediate countershock versus those who did not.
- Analysis of demographic data, prehospital interventions (intubation, vascular access), and time metrics.
Main Results:
- Of 90 asystolic patients, 49 received countershock. Rhythm change occurred in 20% of countershocked vs. 22% of non-countershocked patients.
- No significant difference in survival rates between groups; one patient survived in the non-countershocked group.
- Countershock treatment significantly increased time spent at the scene (23.8 vs. 14.7 minutes) and was associated with greater vascular access success.
Conclusions:
- Prehospital countershock treatment for pediatric asystole does not improve rhythm change or survival.
- Immediate countershock prolongs prehospital care duration without demonstrated benefit in this population.
- Prehospital countershock treatment for asystolic pediatric patients is not recommended.
Abstract:
Prehospital care was retrospectively reviewed in 117 pulseless nonbreathing (PNB) pediatric patients (0 to 18 years of age) to determine the effects of immediate countershock treatment of asystole. Of 90 (77%) children with an initial rhythm of asystole, 49 (54%) received countershock treatment. Rhythm change occurred in ten (20%) of the asystolic children who received countershock treatment. Three of the countershocked asystolic children were successfully resuscitated, but none survived. Rhythm change occurred in nine (22%) of the asystolic children not countershocked. Six were successfully resuscitated, and one survived. The two groups (countershocked asystole v noncountershocked asystole) did not differ significantly in age, sex, witnessed arrest, witnessed arrest with bystander basic life support (BLS), prehospital endotracheal intubation, both intubation and vascular access success, or diagnosis. However, prehospital vascular access was successfully established in a significantly greater number of countershocked patients (P less than .05). The mean times to the scene, at the scene, and to the hospital for the countershocked v noncountershocked asystolic patients were 6.2, 23.8, and 6.1 v 5.9, 14.7 and 7.0 minutes. The mean time at the scene was significantly greater in the countershock group (P less than .001). The successful performance of prehospital endotracheal intubation was significantly associated with rhythm change (P less than .05). Patients age, witnessed arrest, witnessed arrest with bystander BLS, successful establishment of prehospital vascular access, diagnosis, and countershock treatment were not significantly associated with rhythm change. In conclusion, prehospital countershock treatment prolonged prehospital care time and was not associated with rhythm change in asystolic children. Therefore, prehospital countershock treatment of asystolic children is not recommended.