Initial Shockable Rhythms Predict Survival in Pediatric Cardiac Arrest

TUCSON, Ariz., May 31 ? Survival is best in children who have an in-hospital cardiac arrest if a shockable rhythm?ventricular arrhythmia or tachycardia?is present initially, according to an analysis of data from 1,005 events.

Thirty-five percent of children with initial ventricular fibrillation or tachycardia survived to discharge versus an 11% survival for patients who developed ventricular fibrillation or tachycardia during cardiopulmonary resuscitation, presumably a reperfusion arrhythmia, researchers reported in the June 1 issue of the New England Journal of Medicine.

Ricardo A. Samson, M.D. of the Steele Children's Research Center at the University of Arizona wrote that this finding emphasizes the "importance of early electrocardiographic monitoring during resuscitation, because the shockable rhythms of ventricular fibrillation or tachycardia occurred in more than 25% of these children."

Dr. Samson and colleagues here and Children's Hospital of Philadelphia documented ventricular fibrillation or tachycardia in 272 children from an initial sample of 1,005.

One hundred and four children had ventricular fibrillation or tachycardia as the initial pulseless rhythm, and in 149 it developed during CPR. In nineteen patients the time of initiation of ventricular fibrillation or tachycardia was not documented so these cases were excluded from the analysis.

Seven hundred and thirty-three patients had no documented ventricular fibrillation or tachycardia, but 131 of these were excluded because initial rhythm was unknown.

Among the findings:

• Duration of CPR was less than 15 minutes in 44% of patients with initial ventricular fibrillation or tachycardia versus 14% of those with subsequent ventricular fibrillation or tachycardia (P