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Resuscitation. 2019 Apr 25;139:241-252. doi: 10.1016/j.resuscitation.2019.04.028. [Epub ahead of print]

Defibrillation energy dose during pediatric cardiac arrest: Systematic review of human and animal model studies.

Author information

1
Centre de recherche du CHU de Québec, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5605, Canada; Département de médecine familiale et médecine d'urgence, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Local 4617, Canada; Department of Epidemiology and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Centre de recherche sur les soins et les services en première ligne de l'Université Laval, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5604, Canada. Electronic address: Eric.mercier@fmed.ulaval.ca.
2
Département de médecine familiale et médecine d'urgence, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Local 4617, Canada.
3
Department of Epidemiology and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia.
4
Centre de recherche du CHU de Québec, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5605, Canada; Département de médecine familiale et médecine d'urgence, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Local 4617, Canada; Centre de recherche sur les soins et les services en première ligne de l'Université Laval, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5604, Canada.
5
Centre de recherche du CHU de Québec, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5605, Canada; Département de médecine familiale et médecine d'urgence, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Local 4617, Canada; Department of Epidemiology and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Centre de recherche sur les soins et les services en première ligne de l'Université Laval, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5604, Canada.
6
Département de médecine familiale et médecine d'urgence, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Local 4617, Canada; Centre de recherche du CHU de Québec, Axe Santé des Populations et Pratiques Optimales en Santé, 1401, 18e rue, Québec, QC G1J 1Z4, Local D5601, Canada.

Abstract

OBJECTIVE:

To determine the initial defibrillation energy dose that is associated with sustained return of spontaneous circulation (ROSC) during paediatric cardiac arrest with ventricular fibrillation or pulseless ventricular tachycardia.

METHODS:

A systematic review was performed using four databases (PROSPERO: CRD42016036734). Human studies and animal model studies of pediatric cardiac arrest involving assessment of external defibrillation energy dosing were considered. The primary outcome was sustained ROSC. Survival and defibrillation-induced complications were also evaluated.

RESULTS:

The search strategy identified 14,471 citations of which 232 manuscripts were reviewed. Ten human and 10 animal model studies met the inclusion criteria. Human studies were prospective (n = 6) or retrospective (n = 4) cohort studies and included between 11 and 266 patients (median = 46 patients). Sustained ROSC rates ranged from 0 to 61% (n = 7). No studies reported a statistically significant association between the initial defibrillation energy dose and the rate of sustained ROSC (n = 7) or survival (n = 6). Meta-analysis was not considered appropriate due to clinical heterogeneity. Risk of bias was moderate. All animal studies were randomized controlled trials with 8 and 52 (median = 27) piglets. ROSC was frequently achieved (≥85%) with energy dose ranging from 2 to 7 J/kg (n = 7). The defibrillation threshold varied according to the body weight and appears to be higher in infant.

CONCLUSION:

Defibrillation energy doses and thresholds varied according to the body weight and trended higher for infants. No definitive association between initial defibrillation doses and the sustained ROSC or survival could be demonstrated. Clinicians should follow local consensus-based guidelines.

KEYWORDS:

Cardiac arrest; Defibrillation; Pediatric; Ventricular fibrillation

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