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. 2018 Sep 7;1(5):e182643.
doi: 10.1001/jamanetworkopen.2018.2643.

Association Between Time to Defibrillation and Survival in Pediatric In-Hospital Cardiac Arrest With a First Documented Shockable Rhythm

Elizabeth A Hunt  1   2   3 , Jordan M Duval-Arnould  1   2 , Melania M Bembea  2   3 , Tia Raymond  4 , Aaron Calhoun  5 , Dianne L Atkins  6 , Robert A Berg  7 , Vinay M Nadkarni  7 , Michael Donnino  8   9 , Lars W Andersen  9   10 ; American Heart Association’s Get With The Guidelines–Resuscitation Investigators
Affiliations

Association Between Time to Defibrillation and Survival in Pediatric In-Hospital Cardiac Arrest With a First Documented Shockable Rhythm

Elizabeth A Hunt et al. JAMA Netw Open. .

Erratum in

  • Error in Key Points.
    [No authors listed] [No authors listed] JAMA Netw Open. 2018 Oct 5;1(6):e184644. doi: 10.1001/jamanetworkopen.2018.4644. JAMA Netw Open. 2018. PMID: 30646243 Free PMC article. No abstract available.

Abstract

Importance: Delayed defibrillation (>2 minutes) in adult in-hospital cardiac arrest (IHCA) is associated with worse outcomes. Little is known about the timing and outcomes of defibrillation in pediatric IHCA.

Objective: To determine whether time to first defibrillation attempt in pediatric IHCA with a first documented shockable rhythm is associated with survival to hospital discharge.

Design, setting, and participants: In this cohort study, data were obtained from the Get With The Guidelines-Resuscitation national registry between January 1, 2000, and December 31, 2015, and analyses were completed by October 1, 2017. Participants were pediatric patients younger than 18 years with an IHCA and a first documented rhythm of pulseless ventricular tachycardia or ventricular fibrillation and at least 1 defibrillation attempt.

Exposures: Time between loss of pulse and first defibrillation attempt.

Main outcomes and measures: The primary outcome was survival to hospital discharge. Secondary outcomes were return of circulation, 24-hour survival, and favorable neurologic outcome at hospital discharge.

Results: Among 477 patients with a pulseless shockable rhythm (median [interquartile range] age, 4 years [3 months to 14 years]; 285 [60%] male), 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% [11 of 23] vs 72% [268 of 371]; P = .01]). Thirty-eight percent (179 patients) survived to hospital discharge. The median (interquartile range) 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 (risk ratio [RR] per minute increase, 0.96; 95% CI, 0.92-1.01; P = .15) or adjusted analysis (RR, 0.99; 95% CI, 0.94-1.06; P = .86). 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 (132 of 338 [39%] vs 47 of 139 [34%]; RR, 0.87; 95% CI, 0.66-1.13; P = .29) or multivariable analysis (RR, 0.99; 95% CI, 0.75-1.30; P = .93). Time to first defibrillation attempt was also not associated with secondary outcome measures.

Conclusions and relevance: In contrast to published adult IHCA and pediatric out-of-hospital cardiac arrest data, no significant association was observed between time to first defibrillation attempt in pediatric IHCA with a first documented shockable rhythm and survival to hospital discharge.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hunt has received grant funding from the National Institutes of Health that is unrelated to this study. Dr Hunt has received honoraria and reimbursement of travel expenses from Zoll Medical Corporation for speaking engagements on the topic of an educational innovation she created. In addition, Zoll Medical Corporation has a nonexclusive license for the use of educational technology on which Drs Hunt and Duval-Arnould have patents issued. Dr Raymond reported personal fees from Zoll Medical outside the submitted work. Dr Donnino reported grants from the National Heart, Lung, and Blood Institute during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Inclusion and Exclusion Criteria
Of 17 771 pediatric IHCA events, 477 were included in the study. IHCA indicates in-hospital cardiac arrest; pVT, pulseless ventricular tachycardia; VF, ventricular fibrillation.
Figure 2.
Figure 2.. Distribution of Time to First Defibrillation Attempt
Proportion of study participants per 1 minute elapsed between loss of pulse and time to first defibrillation attempt.
Figure 3.
Figure 3.. Survival According to Minute of First Defibrillation Attempt
Percentage of patients (with 95% confidence intervals [error bars]) who survived to hospital discharge for each 1 minute elapsed between loss of pulse and time to first defibrillation attempt.
See this image and copyright information in PMC

Comment in

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