title: Prehospital countershock treatment of pediatric asystole.
abstract: Prehospital care was retrospectively reviewed in 117 pulseless nonbreathing (PNB) pediatric patients (0 to 18 years of age) to determine the effects of immediate countershock treatment of asystole. Of 90 (77%) children with an initial rhythm of asystole, 49 (54%) received countershock treatment. Rhythm change occurred in ten (20%) of the asystolic children who received countershock treatment. Three of the countershocked asystolic children were successfully resuscitated, but none survived. Rhythm change occurred in nine (22%) of the asystolic children not countershocked. Six were successfully resuscitated, and one survived. The two groups (countershocked asystole v noncountershocked asystole) did not differ significantly in age, sex, witnessed arrest, witnessed arrest with bystander basic life support (BLS), prehospital endotracheal intubation, both intubation and vascular access success, or diagnosis. However, prehospital vascular access was successfully established in a significantly greater number of countershocked patients (P less than .05). The mean times to the scene, at the scene, and to the hospital for the countershocked v noncountershocked asystolic patients were 6.2, 23.8, and 6.1 v 5.9, 14.7 and 7.0 minutes. The mean time at the scene was significantly greater in the countershock group (P less than .001). The successful performance of prehospital endotracheal intubation was significantly associated with rhythm change (P less than .05). Patients age, witnessed arrest, witnessed arrest with bystander BLS, successful establishment of prehospital vascular access, diagnosis, and countershock treatment were not significantly associated with rhythm change. In conclusion, prehospital countershock treatment prolonged prehospital care time and was not associated with rhythm change in asystolic children. Therefore, prehospital countershock treatment of asystolic children is not recommended.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53201.
authors.forename: J D
authors.initials: JD
authors.lastname: Losek
authors.forename: H
authors.initials: H
authors.lastname: Hennes
authors.forename: P W
authors.initials: PW
authors.lastname: Glaeser
authors.forename: D S
authors.initials: DS
authors.lastname: Smith
authors.forename: G
authors.initials: G
authors.lastname: Hendley
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004554:Electric Countershock; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011674:Pulse; D012151:Resuscitation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology