%0 Journal Article 
%A Rodríguez-Núñez, Antonio
%A López-Herce Cid, Jesús
%A García, Cristina
%A Domínguez Sampedro, Pedro
%A Carrillo, Ángel
%A Bellón Cano, José María
%T Pediatric defibrillation after cardiac arrest: Initial response and outcome
%D 2006
%@ 1364-8535
%U http://hdl.handle.net/10017/6720
%X Introduction 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 oneyear
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.
Conclusion 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 onethird
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.
%K Pediatric defibrillation
%K Cardiac arrest
%K Cirugía
%K Surgery
%K Ciencias de la salud
%K Health sciences
%~ Biblioteca Universidad de Alcala