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Posted

(Acad Emerg Med Volume 13 @ Number 5 525-529,

published online before print March 28, 2006, doi: 10.1197/j.aem.2005.12.019

© 2006 Society for Academic Emergency Medicine CLINICAL PRACTICE

Ventricular Fibrillation in Pediatric Cardiac Arrest

Brian T. Smith, BS, Tom D. Rea, MD, MPH and Mickey S. Eisenberg, MD, PhD

From the Department of Medicine, University of Washington School of Medicine (BTS), Seattle, WA; and Emergency Medical Services Division, Public Health Seattle and King County (TDR, MSE), Seattle, WA.

Address for correspondence: Mickey S. Eisenberg, MD, PhD, Emergency Medical Services Division, Public Health Seattle and King County, 999 Third Avenue, Suite 700, Seattle, WA 98104. Fax: 206-296-4866; e-mail: gingy@u.washington.edu.)

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.

Posted

Okay, so if I'm decoding the great big words here correctly, a greater number of arrests under the age of 8 are non-VF than over the age of 12?

I can't say I'm really surprised, especially considering that many of the <8 arrests were probably SIDS cases. I think the most important thing in treating a peds arrest is to treat it like a PEA, that is, the cause is more important that the rhythm. Despite the increasing amount of juvenile diabetes and heart disease among children (way to go, soccer moms!), kids still are not going into MI's caused by years of inactivity and smoking.

So, the child in arrest is most likely in arrest from either an environmental cause, such as an electrical shock (look for frayed cords, forks in the toaster, pennies in the light sockets), blunt force trauma to the the chest (we had another kid go down from getting hit in the chest with a baseball, he's still fighting for his life in a Jersey hospital), poisonings, or the other is a heart defect such as long Q-T syndrome (ask if anyone in the family died suddenly at a young age). Traumatic arrests also probably figure very heavily in arrests in children, and unfortunately, the prognosis for them is very grim.

Posted

So what was the real purpose of this study...other then to state the obvious.

Posted

Consider at some point in a cardiac arrest, the majority of patients--adult or pediatric--will exhibit a period of VF. The short downtime, or witnessed collapse, is more likely than the longer, unwitnessed collapse. In the pediatric population the period of VF is so short there is really no way for EMS to arrive on scene early enough to witness and treat it.

Posted

The old saying if you see V-fib in a ped's case, check your own pulse... Yeah, this is nothing new than what other previous studies have prevailed. That is why I am concerned that so many EMS and first responder units are so concerned about changing their AED's for pediatric.. <8 % V-fib witnessed = rarely to never in the field. It would be wise to spend your money on proper equipment such as Braslow tape & kits, proper BVM's oxygen supplies and suction catheters.

R/r 911

Posted

So let me get this straight its very slim for a child under 8 to have VF, but any child of any age could suffer and you said 8%.

So why couldnt they suffer a VF, most children will suffer a cardic arrest, just trying to understand what VF is vs. PEA?

Posted

An adult in non traumatic arrest is usually due to arrhythmia's that lead to V-fib, in other words the problem is usually cardiac in nature. Children on the other hand tend to have airway issues which causes them to crash harder and faster. Also children are better at dealing with shock, but when they crash they crash hard. This leads to the caveat airway, airway, airway with children.

Sweet, short and with no Latin. Does that help?

Peace,

Marty

:joker:

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