Is Survival Associated With Time to Defibrillation for In-Hospital Cardiac Arrest in Pediatric Patients?

Bottom Line: The time until a first attempt at defibrillation in pediatric patients who experienced cardiac arrest in the hospital wasn’t associated with survival or other main outcomes. This is in contrast to children who have a cardiac arrest outside of the hospital setting, or adult patients in or out of the hospital, where worse outcomes are associated with defibrillation delayed more than two minutes.

Why The Research Is Interesting: About 6,000 children each year in the United States experience cardiac arrest while in the hospital. In adults, delayed defibrillation attempts of more than two minutes are a national quality measure.

Who and When: Data for 477 pediatric patients younger than 18 from 113 hospitals with an in-hospital cardiac arrest, a documented loss of pulse and least one defibrillation attempt from 2000 to 2015.

What (Study Measures and Outcomes): Time between loss of pulse and first defibrillation attempt (exposure); survival to hospital discharge (primary outcome); return of circulation, 24-hour survival, and favorable neurologic outcome at hospital discharge (secondary outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Elizabeth A. Hunt, M.D., M.P.H., Ph.D., of Johns Hopkins Charlotte Bloomberg Children’s Center, Baltimore, Maryland, and co-authors

Results: Most pediatric patients (71 percent) had a first attempt at defibrillation within two minutes of loss of pulse. There was no difference associated with survival in pediatric patients with a first defibrillation attempt in two minutes or less compared with more than two minutes; time to the first defibrillation attempt also wasn’t associated with the other outcomes. The authors offer several possibilities to explain their results.

Study Limitations: The sample size; that most first defibrillation attempts were within two minutes of loss of pulse; and that the sudden nature of cardiac arrest may have led to some misclassification of time and other variables.

Study Conclusions: 

 

 

 

 

 

 

 

Related Material: The invited commentary, “Shorter Time to Defibrillation in Pediatric CPR — Children Are Not Small Adults But Shock Them Like They Are,” by Alexis Topjian, M.D., M.S.C.E., of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, also is available on the For The Media website.

 

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.2643)