TY - JOUR
T1 - Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest
AU - for the pediRES-Q Investigators
AU - Gray, James M.
AU - Raymond, Tia T.
AU - Atkins, Dianne L.
AU - Tegtmeyer, Ken
AU - Niles, Dana E.
AU - Nadkarni, Vinay M.
AU - Pandit, Sandeep V.
AU - Dewan, Maya
AU - Abulebda, Kamal
AU - Atkins, Dianne
AU - Balikai, Shilpa
AU - Berg, Marc
AU - Berg, Robert
AU - Bhalala, Utpal
AU - Braga, Matthew S.
AU - Buysse, Corinne
AU - Cheng, Adam
AU - Christoff, Andrea
AU - Corbett, Kelly
AU - Decaen, Allan
AU - Dejong, Gabry
AU - Castillo, Jimena Del
AU - Dewan, Maya
AU - Donoghue, Aaron
AU - Duval-Arnould, Jordan
AU - Esangbedo, Ivie
AU - Flaherty, Michael
AU - Frazier, Maria
AU - Friess, Stuart
AU - Gangadharan, Sandeep
AU - Gawronski, Orsola
AU - Gilleland, Jonathan
AU - Griffis, Heather
AU - Gray, James
AU - Harvey, Helen
AU - Harwayne-Gidansky, Ilana
AU - Haskell, Sarah
AU - Hayes, Jennifer
AU - Heber, Kiran
AU - Hunt, Betsy
AU - Ikeyama, Takanari
AU - Jani, Priti
AU - Daniels, Katherine
AU - Kleinman, Monica
AU - Knight, Lynda
AU - Kurosawa, Hiroshi
AU - Lasa, Javier
AU - Lauridsen, Kasper Glerup
AU - Lemoine, Tara
AU - Maa, Tensing
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - 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.
AB - 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.
KW - children
KW - defibrillation
KW - ventricular fibrillation
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85166442071&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85166442071&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000003241
DO - 10.1097/PCC.0000000000003241
M3 - Article
C2 - 37115167
AN - SCOPUS:85166442071
SN - 1529-7535
VL - 24
SP - E390-E396
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 8
ER -