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

James M Gray^1,2, 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

Summary

This summary is machine-generated.

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.

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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.