title: Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest.
abstract: OBJECTIVE
  To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective.
  
  
  METHODS
  This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000-2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose.
  
  
  RESULTS
  Of 266 children with 285 events, 173 of 285 (61%) survived the event and 61 of 266 (23%) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53%) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56% vs 91%; P < .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95% confidence interval: 0.21-0.81]) and event survival (odds ratio: 0.42 [95% confidence interval: 0.18-0.98]).
  
  
  CONCLUSIONS
  The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.
authors.affiliation: Department of Anesthesiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meaney
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Atkins
authors.forename: Marc D
authors.initials: MD
authors.lastname: Berg
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Samson
authors.forename: Mary Fran
authors.initials: MF
authors.lastname: Hazinski
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004554:Electric Countershock / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D011446:Prospective Studies