Time to First Defibrillation May Not Affect Pediatric Cardiac Arrest Survival Rates

For children who experience in-hospital cardiac arrest, the time to first defibrillation was not associated with survival outcomes, but a shorter duration of CPR could improve survival to discharge, according to a study published in JAMA Network Open.

The author of this study sought to evaluate the association between time to first defibrillation attempt and survival outcomes in children who experienced their first documented rhythm of pulseless ventricular tachycardia or ventricular fibrillation.

Using the American Heart Association Get With The Guidelines Resuscitation registry, the author identified a cohort of 997 children with a first documented rhythm of pulseless ventricular tachycardia or ventricular fibrillation, but only 477 patients had analyzable data. If treatment followed Pediatric Advanced Life Support guidelines, most of these pediatric patients probably received CPR prior to defibrillation, increasing blood flow and improving defibrillation outcomes.  

The majority of pediatric in-hospital cardiac arrest events occurred in the ICU; the median time to first defibrillation attempt was 1 minute, and 71% of pediatric patients received their initial shock within 2 minutes of ventricular tachycardia or ventricular fibrillation.

Three-quarters of these patients were critically ill (44% experienced hypotension and/or needed vasopressor administration, 49% experienced respiratory insufficiency, and 69% required mechanical ventilation).

Remarkably, 73% of these patients achieved a return of circulation, and 38% survived to discharge. After adjusting for variables, the author observed no association between time to first defibrillation attempt and survival to discharge (risk ratio, 0.99; 95% CI, 0.94-1.06; P =.86).

Limitations of the study include a small cohort due to the small number of pediatric cardiac arrests that occur annually and the difficulty of performing a controlled trial with randomly assigned participants to research pediatric resuscitation.

The author concludes that, although the time to first defibrillation was not independently associated with survival outcomes, a shorter CPR duration is linked to higher rates of survival to discharge. The data described in this study supports standards of pediatric care that include rapid recognition of cardiac events and a prompt defibrillation attempt.

Reference                                                                                                                       

Topjian A. Shorter time to defibrillation in pediatric CPR: children are not small adults, but shock them like they are [published online September 21, 2018]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2018.2653