Shock Dose When Defibrillating Children

Cardiac arrest in children is certainly less frequent than in adults. However most paediatric in-hospital cardiac arrests do not survive to discharge.

Shockable rhythms are associated with a higher rate of survival. However there is some disagreement as to the first shock dose delivered and if it makes a difference:

The Australian Resuscitation guidelines recommend 4 J/kg
The American Heart Association PALS recommends 2 – 4 J/kg
The European Resuscitation Council recommends 4 J/kg

This paper tested the hypothesis that a first energy dose of 2 J/kg was associated with a higher rate of survival in children with a shockable rhythm.

Home DB et al. Improved Survival to hospital discharge in paediatric in-hospital cardiac arrest using 2Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia. Resuscitation153(2020) 88-96

Study Type: Multicentre Prospective database of in-hospital cardiac arrest.
Patient Type: < 18 yo, n= 803 patients
Primary Outcome: Survival to hospital Discharge
Secondary Outcome: ROSC

RESULTS

< 12 year olds:
Survival to hospital discharge was significantly lower when first energy doses fell outside the range 1.7-2.5 J/kg. There was no difference in ROSC.

When looking at all patients < 18 yo:
There was no difference in survival to hospital discharge with a first dose of 1.7-2.5 J/kg, when compared with other doses.
Those patients with VF who had a shock energy > 2.5 J/kg demonstrated worst odds to survival to hospital discharge.
There was no difference in ROSC

CONCLUSIONS: What I take away from this.

First shock doses >2.5 J/kg were associated with worst outcome, especially in the <12 years old group.

I will be using 2 J/kg as my first defibrillation dose for VF or pulseless VT