Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation.
OBJECTIVE
To compare the safety and efficacy of attenuated adult biphasic shocks with standard monophasic weight-based shocks in a piglet model of prolonged prehospital ventricular fibrillation (VF).


BACKGROUND
If attenuated adult shocks are safe and effective for prehospital pediatric VF, automated external defibrillators (AEDs) can be easily adapted for pediatric use.


METHODS
After 7 min of untreated VF, piglets were randomized to treatment with attenuated adult biphasic shocks or weight-based monophasic shocks. The attenuated adult biphasic group received 200/300/360 J shocks, attenuated by specialized pediatric electrodes to 51/78/81 J and the monophasic weight-based control group received 2/4/4 J/kg shocks. Forty-eight female piglets were studied, 16 in each of three weight categories: 4 kg (neonatal), 14 kg (younger child) and 24 kg (older child). The primary outcome measures of efficacy and safety were 24h survival with good neurological outcome and post-resuscitation left ventricular ejection fraction (LVEF), respectively.


RESULTS
For the 24 kg piglets, attenuated adult biphasic shocks resulted in superior 24 h survival with good neurological outcome (6/8 versus 0/8, P < 0.001) and greater LVEF 4 h post-resuscitation (34 +/- 4% versus 18 +/- 5%, P < 0.05). For the 14 and 4 kg piglets, 24 h survival with good neurological outcome occurred in 7/8 versus 5/8 and 7/8 versus 3/8, respectively, and LVEF 4 h post-resuscitation was 30 +/- 3% versus 36 +/- 6% and 30 +/- 3% versus 22 +/- 4%, respectively.


CONCLUSIONS
The escalating attenuated adult biphasic dosage strategy was at least as safe and effective as the standard weight-based monophasic dose over a wide range of weights in this piglet model of prehospital VF. This work supports the concept of using an attenuated adult biphasic dosage in children.
Berg
Robert A
RA
The University of Arizona Steele Memorial Children's Research Center, Tuscon, AZ 85724-5073, USA. rberg@peds.arizona.edu
Chapman
Fred W
FW
Berg
Marc D
MD
Hilwig
Ronald W
RW
Banville
Isabelle
I
Walker
Robert G
RG
Nova
Richard C
RC
Sherrill
Duane
D
Kern
Karl B
KB
D000818:Animals; D000831:Animals, Newborn; D001835:Body Weight; D004195:Disease Models, Animal; D004554:Electric Countershock / Q000379:methods* / Q000401:mortality*; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D010372:Pediatrics; D011336:Probability; D011897:Random Allocation; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013552:Swine; D014693:Ventricular Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*