Ventricular Fibrillation in Pediatric Cardiac Arrest

Abstract

Objectives: After activating 9-1-1 for out-of-hospital cardiac arrest (CA), guidelines for children 1 year and older have evolved to include immediate automated external defibrillator (AED) use for witnessed arrest, and two minutes of cardiopulmonary resuscitation (CPR) followed by AED use for unwitnessed arrests. The best approach to resuscitation in a two-tiered emergency medical services (EMS) system depends in part on how likely the patient is to present with ventricular fibrillation (VF). Therefore, the authors evaluated the frequency of VF with respect to age and other characteristics to further elucidate the role of the AED among pediatric CAs. Methods:The investigation was a retrospective cohort study of EMS-treated, nontraumatic, out-of-hospital CA among persons aged 1-18 years in King County, Washington, between April 1, 1976, and December 31, 2003. The primary goal was to identify the proportion of patients presenting to EMS in VF, according to age. The association between other characteristics and the likelihood of VF was also evaluated. Finally, hospital survival according to cardiac rhythm at EMS arrival was evaluated.Results: Ventricular fibrillation was the presenting rhythm in 17.6% of cases (48/272). The proportion presenting with VF was 7.6% (10/131) among children aged 1-7 years and 27.0% (38/141) among children aged 8-18 years (p < 0.001). In multivariable models, VF was independently associated with age 8 years and older compared with 1-7 years (odds ratio, 3.19; 95% confidence interval [CI] = 1.46 to 6.97), witnessed arrest (odds ratio, 3.33; 95% CI = 1.63 to 6.82), and cardiac etiology (odds ratio, 2.89; 95% CI = 1.32 to 6.34). Survival was 31.3% (15/48) for VF and 10.7% (24/224) for nonshockable rhythm CAs. Conclusions:The proportion of children aged younger than 8 years presenting with VF is low compared with older children. The greatest increase in VF proportion occurs in children older than 12 years. Based on these results, the best approach for initial EMS resuscitation in a two-tiered EMS system, CPR versus AED use, is uncertain among younger children. Inclusion of witness status into the decision process for younger children may more efficiently allocate AED use, a finding in accordance with 2005 guidelines.ACADEMIC EMERGENCY MEDICINE 2006; 13:525-529 ª

Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

“…Two studies reported VF as the initial rhythm in 19% to 24% of out-of-hospital pediatric cardiac arrests after excluding sudden infant death syndrome (SIDS) deaths. In studies that included SIDS victims, the frequency decreased to the range of 6% to 10%; however, SIDS patients typically are asystolic, because they have been dead long before emergency medical services arrival 99. The incidence of VF varies according to setting and age 100.…”

Out-of-hospital ventricular fibrillation in three adolescents

“…A retrospective study on pulseless patients less than 20 years of age showed that ventricular fibrillation was the initial rhythm in 19% of patients, excluding those less than 6 months of age who died as a result of sudden infant death syndrome 1. A retrospective study of cardiac arrest reported ventricular fibrillation rates of 7.6% for children 1–7 years of age and 27.0% for children 8–18 years of age, with an overall incidence of ventricular fibrillation of 17.6% 2. Many guidelines, including those of the International Liaison Committee on Resuscitation, the American Heart Association (AHA), and the National Association of EMS Physicians, now advocate AED use on children to analyse rhythms and provide early defibrillation in cases of ventricular fibrillation 3 – 5…”

Ventricular fibrillation and defibrillation

“…VF is more widely observed in adults and older children at the time of cardiac arrest 24 38 39. Bradycardia is the most common terminal cardiac rhythm in children prior to death40 and has a significantly worse survival 27 34.…”