Abstract 11594: Initial Energy Dose and Survival to Hospital Discharge for Pediatric In-hospital Cardiac Arrest Due to Pulseless Ventricular Arrhythmia

The American Heart Association (AHA) recommends an initial defibrillation energy dose of 2 J/kg to treat pediatric in-hospital cardiac arrest (IHCA) with initial ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, the optimal energy dose remains unclear.Methods:Using data from the AHA Get With the Guidelines-Resuscitation?, we identified children ?12 years with IHCA and an initial arrest rhythm of VF/pVT. Current Pediatric Basic Life Support guidelines recommend weight-based defibrillation for these pre-pubertal children. Primary exposure was energy dose in joules/kilogram (J/kg), calculated by dividing recorded energy (J) by recorded weight (kg). To account for rounding errors, we categorized energy doses as follows: 1.7-2.5 J/kg as reference (reflecting a 2 J/kg intended energy dose), <1.7 J/kg and >2.5 J/Kg. The latter two categories were combined for sample size considerations. We compared survival for initial energy doses of 1.7-2.5 J/kg to all other doses. We constructed multivariable logistic regression models to test the association of energy dose with survival, adjusting for age, arrest location, illness category, initial rhythm and vasoactive medications.Results:We identified 301 patients ?12 years with index IHCA and initial VF or pVT. 4% of patients ?12 had energy ?120 J, the recommended initial adult dose. Survival to hospital discharge was significantly lower when energy doses other than 1.7-2.5 J/kg were used (adjusted odds ratio [aOR] 0.64; 95% confidence interval [CI] 0.44-0.89; p<0.01). Individual dose categories of either <1.7 J/kg (aOR 0.73 95% CI 0.47-1.15; p=0.18) or >2.5 J/kg (aOR 0.55 95% CI 0.29-1.04; p=0.06), were not associated with differences in survival to discharge compared to 1.7-2.5 J/kg. In sensitivity analysis of patients with initial VF (n=170), an initial energy dose >2.5 J/kg was associated with worse survival (aOR 0.44, 95% CI 0.21-0.90; P=0.03), compared to an initial dose of 1.7-2.5 J/kg.Conclusions:Initial energy doses other than 2 J/kg for IHCA presenting with VF/pVT are associated with worse survival to hospital discharge in patients ?12 years. Results support current AHA guidelines of initial energy dose of 2 J/kg in preadolescent patients and those with initial VF.