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Subsequent Shockable Rhythm During Out-of-Hospital Cardiac Arrest in Children With Initial Non-Shockable Rhythms: A

Yoshikazu Goto1, Akira Funada2, Yumiko Goto3

  • 1Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan gotoyosh@med.kanazawa-u.ac.jp.

Journal of the American Heart Association
|October 30, 2016
PubMed

Insights

In children with out-of-hospital cardiac arrest, a shockable rhythm during resuscitation improved survival and neurological outcomes. However, for older children, delayed shock delivery worsened these results.

Area of Science:

  • Pediatric Emergency Medicine
  • Cardiology
  • Resuscitation Science

Background:

  • Out-of-hospital cardiac arrest (OHCA) in children with initial nonshockable rhythms presents a significant challenge.
  • The impact of developing a shockable rhythm during cardiopulmonary resuscitation (CPR) on pediatric OHCA outcomes is not well understood.

Purpose of the Study:

  • To investigate whether a subsequent treated shockable rhythm during CPR improves survival with favorable neurological outcomes in children with OHCA and initial nonshockable rhythms.
  • To analyze the influence of time to shock delivery on outcomes in this pediatric population.

Main Methods:

  • Analysis of the All-Japan Utstein Registry, including 12,402 children (<18 years) with OHCA and initial nonshockable rhythms.
  • Comparison of outcomes between two cohorts: those who developed a subsequent treated shockable rhythm (n=239) and those who did not (n=12,163).
  • Assessment of 1-month survival with favorable neurological outcomes using the Cerebral Performance Category (CPC) scale (1-2).

Main Results:

  • The cohort with a subsequent treated shockable rhythm showed a significantly higher rate of 1-month CPC 1-2 (4.6%) compared to the no subsequent shockable rhythm cohort (1.3%) (adjusted odds ratio, 2.90; P<0.001).
  • In the subsequent shockable rhythm cohort, favorable neurological outcomes decreased significantly as time to shock delivery increased (17.7% for 0-9 min vs. 0% for 20-59 min; P<0.001 for trend).
  • No significant difference in outcomes was observed between the cohorts for children younger than 7 years (1.3% vs. 1.4%; P=0.62).

Conclusions:

  • Subsequent treated shockable rhythm during CPR is associated with improved survival and neurological outcomes in pediatric OHCA with initial nonshockable rhythms.
  • For older children (7-17 years), increased time to shock delivery negatively impacts survival and neurological outcomes.
  • Early defibrillation is crucial for improving outcomes in pediatric OHCA when a shockable rhythm emerges during resuscitation.
Abstract

Keywords:
cardiopulmonary resuscitationdefibrillationepidemiologyheart arrestresuscitation

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