|
May 26, 2006
By
Sahar
Bedrood B.S. and Asher Kimchi M.D.
Tuscan, Arizona - In children, cardiac
arrests are typically presented secondary to a
progressive respiratory failure or shock, rather
than as a primary arrhythmogenic event as seen in
adults. Ventricular fibrillation or tachycardia can
also occur during cardiopulmonary resuscitation
(CPR) for asystole or pulseless electrical activity
as a reperfusion arrhythmia. A study by Robert A.
Berg M.D et al, from the Steele Children’s Research
Center in Arizona, showed that a presentation of
ventricular fibrillation or tachycardia at the
beginning of cardiac arrest results in a better
survival outcome than if the ventricular
fibrillation presented subsequently during CPR. The
study was published in the June 1, 2006 issue of The
New England Journal of Medicine.
Of 1005 index
patients with in-hospital cardiac arrest,
272 (27 percent) had documented ventricular
fibrillation or tachycardia during the
arrest. In 104 patients (10 percent),
ventricular fibrillation or tachycardia was the
initial pulseless rhythm; in 149 patients
(15 percent), it developed during the
arrest. The time of initiation of ventricular
fibrillation or tachycardia was not
documented in 19 patients. Thirty-five percent
of patients with initial ventricular
fibrillation or tachycardia survived to
hospital discharge, as compared with 11 percent
of patients with subsequent ventricular
fibrillation or tachycardia (odds ratio,
2.6; 95 percent confidence interval, 1.2 to 5.8).
Twenty-seven percent of patients with no
ventricular fibrillation or tachycardia
survived to hospital discharge, as compared with
11 percent of patients with subsequent
ventricular fibrillation or tachycardia
(odds ratio, 3.8; 95 percent confidence interval,
1.8 to 7.6).
In pediatric patients with in-hospital cardiac
arrests, survival outcomes were highest
among patients in whom ventricular
fibrillation or tachycardia was present initially
than among those in whom it developed
subsequently. The outcomes for patients
with subsequent ventricular fibrillation or
tachycardia were substantially worse than
those for patients with asystole or
pulseless electrical activity.
Co-authors: Ricardo A. Samson, M.D., Vinay M.
Nadkarni, M.D., Peter A. Meaney, M.D., M.P.H., Scott
M. Carey, Marc D. Berg, M.D., Robert A. Berg, M.D.,
for the American Heart Association National Registry
of CPR Investigators
| 
