학술논문
Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest
Document Type
Academic Journal
Author
Gray, James M.; Raymond, Tia T.; Atkins, Dianne L.; Tegtmeyer, Ken; Niles, Dana E.; Nadkarni, Vinay M.; Pandit, Sandeep V.; Dewan, Maya; Abulebda, Kamal; Atkins, Dianne; Balikai, Shilpa; Berg, Marc; Berg, Robert; Bhalala, Utpal; Braga, Matthew S.; Buysse, Corinne; Cheng, Adam; Christoff, Andrea; Corbett, Kelly; DeCaen, Allan; deJong, Gabry; Castillo, Jimena del; Dewan, Maya; Donoghue, Aaron; Duval-Arnould, Jordan; Esangbedo, Ivie; Flaherty, Michael; Frazier, Maria; Friess, Stuart; Gangadharan, Sandeep; Gawronski, Orsola; Gilleland, Jonathan; Griffis, Heather; Gray, James; Harvey, Helen; Harwayne-Gidansky, Ilana; Haskell, Sarah; Hayes, Jennifer; Heber, Kiran; Hunt, Betsy; Ikeyama, Takanari; Jani, Priti; Daniels, Katherine; Kleinman, Monica; Knight, Lynda; Kurosawa, Hiroshi; Lasa, Javier; Lauridsen, Kasper Glerup; Lemoine, Tara; Maa, Tensing; Masse, Elizabeth; Mejia, Luz Marina; Meyer, Michael; Mok, Yee Hui; Morgan, Ryan; Nadkarni, Vinay; Nett, Sholeen; Niles, Dana; O’Halloran, Amanda; Olson, Michelle; Ong, Gene; Rajapreyar, Prakad; Raymond, Tia; Roberts, Joan; Sen, Anita; Skellet, Sophie; Stromberg, Daniel; Su, Felice; Sutton, Robert; Sweberg, Todd; Tegg, Oscar; Tegtmeyer, Ken; Topjian, Alexis; Van Ittersum, Wendy; Villaescusa, Javier Urbano; Watanabe, Ichiro; Welsby, Denise; Wenger, Jesse; Wolfe, Heather; Yeo, Andrea; Yu, Pricilla
Source
Pediatric Critical Care Medicine. Aug 01, 2023 24(8):e390-e396
Subject
Language
English
ISSN
1529-7535
Abstract
OBJECTIVES:: To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA). DESIGN:: Retrospective cohort study. SETTING:: An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q]. PATIENTS:: All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We analyzed 418 shocks delivered during 159 cardiac arrest events, with 381 shocks during 158 events at 28 sites remaining after excluding undecipherable rhythms. We classified shocks as: 1) appropriate (ventricular fibrillation [VF] or wide complex ≥ 150/min); 2) indeterminate (narrow complex ≥ 150/min or wide complex 100–149/min); or 3) inappropriate (asystole, sinus, narrow complex < 150/min, or wide complex < 100/min) based on the rhythm immediately preceding shock delivery. Of delivered shocks, 57% were delivered appropriately for VF or wide complex rhythms with a rate greater than or equal to 150/min. Thirteen percent were classified as indeterminate. Thirty percent were delivered inappropriately for asystole (6.8%), sinus (3.1%), narrow complex less than 150/min (11%), or wide complex less than 100/min (8.9%) rhythms. Eighty-eight percent of all shocks were delivered in ICUs or emergency departments, and 30% of those were delivered inappropriately. CONCLUSIONS:: The rate of inappropriate shock delivery for pediatric IHCA in this international cohort is at least 30%, with 23% delivered to an organized electrical rhythm, identifying opportunity for improvement in rhythm identification training.