Abstract 158: Adult Defibrillation Shocks Do Not Cause Cardiac Damage In A Pediatric Porcine Model

Abstract

Introduction: AEDs often utilize specific modes for treating pediatric patients, enabling reduced energy defibrillation and pediatric specific guidance on performing CPR. If a pediatric mode is not available, current guidelines recommend use of adult mode. It is not fully understood if delivery of adult mode shocks or CPR results in cardiac damage in children. The aim of this pilot study was to observe the effects of delivering either adult shocks or CPR during sinus rhythm in pediatric weight swine. Methods: Six anesthetized swine (10-12 kg) were studied. Four received three adult unsynchronized shocks (150-150-200 Joules) (HeartSine, UK) without induction of VF to isolate the effect of shocks alone. Two received three, two-minute episodes of CPR. A Philips MRx (Philips, USA) recorded CPR depth. ST-segment deviation was recorded before shocks and at 10-seconds and 60-seconds post-shock. Animals then entered a 4-hour monitoring period were blood samples and echocardiographic images were taken at +2 hours and +4 hours. Results: No shock (0/12) or episode of CPR (0/6) delivered during sinus rhythm resulted in conversion to an arrest rhythm. CPR was delivered at depths between 21 and 39 mm. There was no significant change in ST-segment deviation, cardiac troponin I, creatine phosphokinase or left ventricular ejection fraction from baseline values for either group (Table 1). Additionally, there were no significant differences between the two groups for any endpoint. Conclusions: Neither adult energy shocks nor CPR delivered to pediatric weight pigs resulted in significant adverse effects by any metric analyzed. This suggests that application of adult shock energies and CPR without experimental confounders (e.g. ischemia, metabolic disturbance) does not result in significant myocardial damage in this model of pediatric resuscitation. Future studies should investigate the effect of guideline depth CPR in this model. Note: this is a pilot study with a limited sample size.