Pediatric defibrillation doses often fail to terminate prolonged out-of-hospital ventricular fibrillation in children

Part 14: Pediatric Advanced Life Support

“…It has been observed that in children with VF, an initial monophasic dose of 2 J/kg is only effective in terminating ventricular fibrillation 18% to 50% of the time, 269,270 while similar doses of biphasic shocks are effective 48% of the time. 268 Children with out-of-hospital VF cardiac arrest often receive more than 2 J/kg, 271,272 and one in-hospital cardiac arrest study 268 showed that children received doses between 2.5 and 3.2 J/kg to achieve ROSC.…”

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

“…54 Conversion from VF was demonstrated in both studies with either 2 J/kg 57 or 2 to 4 J/kg. 54 For the important outcome of ROSC, we identified very-low-quality evidence from 1 pediatric observational study of IHCA (downgraded for indirectness, imprecision, and serious risk of bias) 55 of 40 subjects, showing no benefit to a specific energy dose for initial defibrillation (P50.11).…”

“…54 Conversion from VF was demonstrated in both studies with either 2 J/kg 57 or 2 to 4 J/kg. 54 For the important outcome of ROSC, we identified very-low-quality evidence from 1 pediatric observational study of IHCA (downgraded for indirectness, imprecision, and serious risk of bias) 55 of 40 subjects, showing no benefit to a specific energy dose for initial defibrillation (P50.11). In addition, we identified very-low-quality evidence from 1 pediatric observational study of IHCA (downgraded for imprecision and serious risk of bias) 58 of 285 subjects showing that an initial shock of greater than 3 to 5 J/kg is less effective than 1 to 3 J/kg (OR, 0.42; 95% CI, 0.18-0.98; P50.04).…”

“…For the critical outcome of survival to hospital discharge, we identified verylow-quality evidence from 3 pediatric observational studies of IHCA and OHCA (downgraded for indirectness, imprecision, and serious risk of bias) [54][55][56] of 108 subjects showing no advantage to 2 to 4 J/kg as an initial defibrillation dose over any other specific energy dose (possible absolute effect size range, 18.5%-6.5%).…”

Singapore Paediatric Resuscitation Guidelines 2016

“…In the 2015 guidelines, the ERC recommends 4 J/kg, while the AHA recommends 2 J/kg for the fi rst shock and 4 J/kg for subsequent shocks. (59)(60)(61)(62) (a) Energy dose Two small case series demonstrated termination of VF/pVT with either 2 J/kg or 2-4 J/kg. In an observational study on IHCA, Meaney et al (63) reported that a higher initial energy dose of > 3-5 J/kg was less effective than a dose of 1-3 J/kg in achieving ROSC.…”