title: Pediatric defibrillation after cardiac arrest: initial response and outcome.
abstract: BACKGROUND
  Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children.
  
  
  METHODS
  Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and 1-year survival. Characteristics of patients and of resuscitation were evaluated.
  
  
  RESULTS
  Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation.
  
  
  CONCLUSIONS
  Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than one-third of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest.
authors.affiliation: Pediatric Emergency and Critical Care Division, Department ofPediatrics, Hospital Clínico Universitario de Santiago de Compostela, Spain. Antonio.Rodriguez.Nunez@sergas.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Núñez
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
authors.forename: Cristina
authors.initials: C
authors.lastname: García
authors.forename: Pedro
authors.initials: P
authors.lastname: Domínguez
authors.forename: Angel
authors.initials: A
authors.lastname: Carrillo
authors.forename: Jose María
authors.initials: JM
authors.lastname: Bellón
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D047548:Defibrillators; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome