Defibrillator and dispatch center clock synchronization is essential for time-sensitive treatment of cardiac arrest (original) (raw)
Related papers
Circulation, 2003
On the basis of the published evidence to date, the Pediatric Advanced Life Support (PALS) Task Force of the International Liaison Committee on Resuscitation (IL-COR) has made the following recommendation (October 2002): • Automated external defibrillators (AEDs) may be used for children 1 to 8 years of age who have no signs of circulation. Ideally the device should deliver a pediatric dose. The arrhythmia detection algorithm used in the device should demonstrate high specificity for pediatric shockable rhythms, ie, it will not recommend delivery of a shock for nonshockable rhythms (Class IIb). In addition: • Currently there is insufficient evidence to support a recommendation for or against the use of AEDs in children Ͻ1 year of age. • For a lone rescuer responding to a child without signs of circulation, the task force continues to recommend provision of 1 minute of CPR before any other action, such as activating the emergency medical services (EMS) system or attaching the AED. • Defibrillation is recommended for documented ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) (Class I). The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 11, 2003. A single reprint is available by calling 800-242-8721
2000
On the basis of the published evidence to date, the Pediatric Advanced Life Support (PALS) Task Force of the International Liaison Committee on Resuscitation (IL-COR) has made the following recommendation (October 2002): • Automated external defibrillators (AEDs) may be used for children 1 to 8 years of age who have no signs of circulation. Ideally the device should deliver a pediatric dose. The arrhythmia detection algorithm used in the device should demonstrate high specificity for pediatric shockable rhythms, ie, it will not recommend delivery of a shock for nonshockable rhythms (Class IIb). In addition: • Currently there is insufficient evidence to support a recommendation for or against the use of AEDs in children Ͻ1 year of age. • For a lone rescuer responding to a child without signs of circulation, the task force continues to recommend provision of 1 minute of CPR before any other action, such as activating the emergency medical services (EMS) system or attaching the AED. • Defibrillation is recommended for documented ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) (Class I). The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 11, 2003. A single reprint is available by calling 800-242-8721
Shockable rhythms and defibrillation during in-hospital pediatric cardiac arrest
Resuscitation, 2014
Introduction Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. Methods Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and oneyear survival. Characteristics of patients and of resuscitation were evaluated. Results Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation. Conclusion Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than onethird of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest.
Use of the Wearable External Cardiac Defibrillator in Children
Pacing and Clinical Electrophysiology, 2010
The wearable cardiac defibrillator (WCD) is an alternative to the implantation of cardioverter defibrillator (ICD) for patients at risk for sudden death who do not fulfill standard criteria for ICD implantation or in whom the risk:benefit ratio is equivocal. Published data pertaining to the WCD in children is sparse. We describe the utility of the WCD in children at a single tertiary care center.
Efficacy and safety of non-transvenous cardioverter defibrillators in infants and young children
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2018
Implantable cardioverter defibrillators (ICD) protect from sudden cardiac death (SCD). In infants and young children, ICD implantation and programming is challenging due to small body size, elevated heart rates, and high physical activity. We report our experience applying a non-transvenous ICD (NT-ICD) system to infants and children < 12 years of age and < 45-kg body weight. Between 07/2004 and 07/2016, NT-ICD had been implanted in 36 patients. Nine out of 36 patients (25%) had NT-ICD implantation for primary and 27/36 (75%) for secondary prevention. Underlying diseases included inherited primary electrical arrhythmogenic diseases (n = 26; 72%), cardiomyopathies (n = 8; 22%), and congenital heart defects (n = 2; 6%). The median (interquartile range) age at implantation was 6 (1.9-8.4) years, and the median body weight was 21.7 (11.2-26.8) kg. Three different NT-ICD implantation techniques had been applied over time: (1) abdominal device/subcutaneous shock coil, (2) abdominal ...
2010
; for the Pediatric Electrophysiology Society Background. During the past decade, the implantable cardioverter-defibrillator (ICD) has emerged as the primary therapeutic option for survivors of sudden cardiac death (SCD). Investigation of the clinical efficacy of these devices has primarily assessed outcome in adults with coronary artery disease. The purpose of this cooperative, international study was to evaluate the impact of ICDs on the pediatric population of SCD survivors, based on an analysis of the clinical characteristics and outcomes of young patients who underwent ICD implantation following an episode of life-threatening ventricular tachycardia or resuscitation from SCD. Methods and Results. An initial data base, established by contacting the manufacturers of the various commercially and investigationally available devices, identified 177 patients who were less than 20 years of age at the time of initial implantation of an ICD. With this data base as a reference, detailed responses were subsequently obtained from physicians involved in the care of 125 (71%) of these patients. The patients ranged in age from 1.9 to 19.9 years (mean, 14.5±4 years) and weighed 9.7-117 kg (mean, 44.6±14 kg). Of the 125 patients, 76% were survivors of SCD, 10% had drug refractory ventricular tachycardia, and 10%'o had syncope with heart disease and inducible sustained ventricular tachyarrhythmias. The most common types of associated cardiovascular disease were hypertrophic and dilated cardiomyopathies (54%), primary electrical diseases (26%), and congenital heart defects (18%). Ventricular function was abnormal in 46% of the patients. During a mean follow-up of 31±23 months, at least one ICD discharge occurred in 85 of the 125 (68%) patients. Seventy-three patients (591%) received at least one appropriate ICD discharge, and 25 patients (20%o) had one or more spurious or indeterminate discharges. Duration of follow-up >24 months (p=0.001) and inducibility of a sustained ventricular arrhythmia (p=0.05) were correlated with appropriate ICD discharges. There were nine deaths during the study period: five sudden, two due to recurrent ventricular arrhythmias, and two related to congestive heart failure. Abnormal ventricular function (p=0.002) and prior ICD discharge (p=0.01) were univariate correlates of patient mortality; by multivariate logistic regression, abnormal ventricular function was the only significant correlate of death (p=0.005). By actuarial analysis, the estimated overall post-ICD implant survival rates at 1, 2, and 5 years were 95%, 93%, and 85%, respectively. The corresponding sudden death-free survival rates were 97%, 95%, and 90%1. Conclusions. Pediatric patients resuscitated from SCD appear to remain at risk for recurrence of life-threatening tachyarrhythmias. During a mean follow-up of 31 months, the ICD provided an effective therapy for such arrhythmias in the majority of patients in this study. Following ICD implant, impaired ventricular function was the primary factor correlated with mortality. The patterns of ICD discharge observed in young patients and, thus, inferred risk of recurrent life threatening arrhythmias are similar to those of adult survivors of SCD. Thus, the use of ICDs in pediatric patients, with implant selection criteria similar to adults, appears valid. (Circulation 1993;87:800-807) KEY WORDs * ventricular arrhythmia * pediatric cardiology * congenital heart diseasecardiomyopathy * cardioverter-defibrillator * sudden cardiac death * children D uring the past decade, advances in the developmany diverse types of cardiovascular disease, evaluation ment of implantable cardioverter-defibrillaof the use of ICDs requires reference to the differing tors (ICDs) have significantly altered both the substrates of SCD.5,6 This type of analysis may be most approach to and prognosis for patients resuscitated relevant in young patients, in whom SCD is an infrefrom sudden cardiac death (SCD).1-4 However, because quent event (one to eight events per 100,000 patient-SCD represents a common final mode of expression for