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Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest

James M Gray1,2, Tia T Raymond3, Dianne L Atkins4

  • 1Department of Pediatrics, University of Cincinnati, Cincinnati, OH.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|April 28, 2023
PubMed

Insights

Inappropriate shock delivery during pediatric cardiac arrest is a significant issue, with at least 30% of shocks being inappropriate. This highlights a critical need for improved rhythm identification training in pediatric resuscitation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiology
  • Resuscitation Science

Background:

  • Inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA) can lead to adverse outcomes.
  • Accurate rhythm identification is crucial for effective defibrillation during resuscitation events.

Purpose of the Study:

  • To characterize the incidence and patterns of inappropriate shock delivery in pediatric IHCA.
  • To identify areas for improvement in the management of pediatric cardiac arrest.

Main Methods:

  • Retrospective cohort study utilizing data from the Pediatric Resuscitation Quality (pediRES-Q) Collaborative.
  • Analysis of 418 shocks delivered during 159 IHCA events (2015-2020) with available electrocardiogram (ECG) waveform data.
  • Classification of shocks as appropriate, indeterminate, or inappropriate based on the pre-shock rhythm.

Main Results:

  • 57% of shocks were appropriate (for ventricular fibrillation or wide complex tachycardia ≥ 150/min).
  • 30% of shocks were inappropriate, delivered for asystole, sinus rhythm, or slow/narrow complex rhythms.
  • Inappropriate shocks were frequently delivered in intensive care units (ICUs) and emergency departments (30% of shocks in these settings).

Conclusions:

  • The rate of inappropriate shock delivery in pediatric IHCA is at least 30%.
  • A significant proportion (23%) of inappropriate shocks were delivered to organized electrical rhythms, indicating potential for error in rhythm interpretation.
  • Improved training in rhythm identification is essential to reduce inappropriate shock delivery and improve outcomes in pediatric resuscitation.
Abstract

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