Biphasic DC shock cardioverting doses for paediatric atrial dysrhythmias.
OBJECTIVE
To determine cardioversion doses of biphasic DC shock for paediatric atrial dysrhythmias.


METHODS
Prospective recording of energy, pre-shock and post-shock rhythms.


METHODS
Paediatric hospital.


METHODS
Shockable atrial dysrhythmias.


RESULTS
Forty episodes of atrial dysrhythmias among 25 children (mean age 6.8+/-7.1 years, mean weight 28.2+/-28.5 kg) were treated with external shock. The first shock converted the dysrhythmia to sinus rhythm in 25 episodes. Cardioversion occurred in 2 of 8 (25%) episodes with a dose of <0.5 J/kg, 14 of 16 (88%) with a dose of 0.5-1.0 J/kg and 9 of 16 (56%) with a dose of >1.0 J/kg (p=0.01, Fisher's exact test). Ten of 15 initially non-responsive episodes were cardioverted with additional shocks at 1.1+/-0.6 J/kg (range 0.5-2.1 J/kg). Of the remaining 5 unresponsive episodes, 2 of ventricular fibrillation (induced by unsynchronized shock) were successfully defibrillated, and 3 were managed with cardiopulmonary bypass. Among 11 additional children (mean age 4.3+/-6.8 years, mean weight 18.1+/-22.0 kg), 18 episodes of atrial dysrhythmias were treated with internal shock which successfully cardioverted all episodes with one or more shocks at 0.4+/-0.2 J/kg.


CONCLUSIONS
In rounded doses, recommended initial external cardioversion doses are 0.5-1.0 J/kg and subsequently up to 2 J/kg, internal cardioversion doses are 0.5 J/kg.
Tibballs
James
J
Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. james.tibballs@rch.org.au
Carter
Bradley
B
Kiraly
Nicholas J
NJ
Ragg
Philip
P
Clifford
Michael
M
D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D001281:Atrial Fibrillation / Q000628:therapy; D001282:Atrial Flutter / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004554:Electric Countershock / Q000379:methods*; D006325:Heart Atria; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D012008:Recurrence; D013610:Tachycardia / Q000628:therapy; D013617:Tachycardia, Supraventricular / Q000628:therapy; D014693:Ventricular Fibrillation / Q000628:therapy