title: Subsequent Shockable Rhythm During Out-of-Hospital Cardiac Arrest in Children With Initial Non-Shockable Rhythms: A Nationwide Population-Based Observational Study.
abstract: The effect of a subsequent treated shockable rhythm during cardiopulmonary resuscitation on the outcome of children who suffer out-of-hospital cardiac arrest with initial nonshockable rhythm is unclear. We hypothesized that subsequent treated shockable rhythm in children with out-of-hospital cardiac arrest would improve survival with favorable neurological outcomes (Cerebral Performance Category scale 1-2).
  
  
  
  From the All-Japan Utstein Registry, we analyzed the records of 12 402 children (aged <18 years) with out-of-hospital cardiac arrest and initial nonshockable rhythms. Patients were divided into 2 cohorts: subsequent treated shockable rhythm (YES; n=239) and subsequent treated shockable rhythm (NO; n=12 163). The rate of 1-month cerebral performance category 1 to 2 in the subsequent treated shockable rhythm (YES) cohort was significantly higher when compared to the subsequent treated shockable rhythm (NO) cohort (4.6% [11 of 239] vs 1.3% [155 of 12 163]; adjusted odds ratio, 2.90; 95% CI, 1.42-5.36; all P<0.001). In the subsequent treated shockable rhythm (YES) cohort, the rate of 1-month cerebral performance category 1 to 2 decreased significantly as time to shock delivery increased (17.7% [3 of 17] for patients with shock-delivery time 0-9 minutes, 7.3% [8 of 109] for 10-19 minutes, and 0% [0 of 109] for 20-59 minutes; P<0.001 [for trend]). Age-stratified outcomes showed no significant differences between the 2 cohorts in the group aged <7 years old: 1.3% versus 1.4%, P=0.62.
  
  
  
  In children with out-of-hospital cardiac arrest and initial nonshockable rhythms, subsequent treated shockable rhythm was associated with improved 1-month survival with favorable neurological outcomes. In the cohort of older children (7-17 years), these outcomes worsened as time to shock delivery increased.
authors: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan gotoyosh@med.kanazawa-u.ac.jp.
authors: Yoshikazu
authors: Y
authors: Goto
authors: Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan.
authors: Akira
authors: A
authors: Funada
authors: Department of Cardiology, Yawata Medical Center, Komatsu, Japan.
authors: Yumiko
authors: Y
authors: Goto
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000628:therapy; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004554:Electric Countershock; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology* / Q000628:therapy; D012042:Registries; D015996:Survival Rate; D013997:Time Factors
keywords: cardiopulmonary resuscitation; defibrillation; epidemiology; heart arrest; resuscitation