No significant association was observed between the time to first defibrillation attempt in pediatric in-hospital cardiac arrest (IHCA) with a first documented shockable rhythm and survival to hospital discharge, according to a study published in the journal JAMA Network Open. The study also reported that time to the first shock was not linked to improved 24-hour survival, the return of circulation, or favorable neurological outcomes.
Delayed defibrillation (>2 minutes) in adult in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Not much is known about the timing and outcomes of defibrillation in pediatric IHCA.
Elizabeth A. Hunt and associates conducted a cohort study to determine whether the time to first defibrillation attempt in pediatric IHCA with a first documented shockable rhythm is associated with survival to hospital discharge.
The researchers collected data from the Get With the Guidelines-Resuscitation national registry and the analysis included 477 children younger than 18 years (median age, 4 years; 60% boys) who experienced an in-hospital cardiac arrest. The study participants included children who had experienced a shockable rhythm (pulseless ventricular tachycardia or ventricular fibrillation) and at least one attempt at defibrillation.
The primary outcome was survival to hospital discharge. Secondary outcomes were the return of circulation, 24-hour survival, and favorable neurologic outcome at hospital discharge.
Key study findings:
- Among 477 patients with a pulseless shockable rhythm,338 (71%) had a first defibrillation attempt at 2 minutes or less after pulselessness.
- Children were less likely to be shocked in 2 minutes or less for ward vs intensive care unit IHCAs (48% vs 72%).
- Thirty-eight percent (179 patients) survived to hospital discharge.
- The median reported time to first defibrillation attempt was 1 minute (0-3 minutes) in both survivors and nonsurvivors.
- Time to first defibrillation attempt was not associated with survival in unadjusted analysis or adjusted analysis.
- There was no difference in survival between those with a first defibrillation attempt in 2 minutes or less vs more than 2 minutes in unadjusted analysis 39% vs 34%.
- Time to first defibrillation attempt was also not associated with secondary outcome measures.
The study concluded that no significant association was observed between time to first defibrillation attempt and survival to hospital discharge.
For reference log on to 10.1001/jamanetworkopen.2018.2643