• Sarah E Haskell, Derek Hoyme, ZimmermanM BridgetMBUniversity of Iowa College of Public Health, Iowa City, IA, United States., Ron Reeder, Saket Girotra, Tia T Raymond, Ricardo A Samson, Marc Berg, Robert A Berg, Vinay Nadkarni, Dianne L Atkins, and American Heart Association's Get With The Guidelines®-Resuscitation Investigators.
• University of Iowa Carver College of Medicine, Iowa City, IA, United States. Electronic address: sarah-haskell@uiowa.edu.
• Resuscitation. 2024 May 1; 198: 110200110200.

BackgroundAnnually 15,200 children suffer an in-hospital cardiac arrest (IHCA) in the US. Ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) is the initial rhythm in 10-15% of these arrests. We sought to evaluate the association of number of shocks and early dose escalation with survival for initial VF/pVT in pediatric IHCA.MethodsUsing 2000-2020 data from the American Heart Association's (AHA) Get with the Guidelines®-Resuscitation (GWTG-R) registry, we identified children >48 hours of life and ≤18 years who had an IHCA from initial VF/pVT and received defibrillation.ResultsThere were 251 subjects (37.7%) who received a single shock and 415 subjects (62.3%) who received multiple shocks. Baseline and cardiac arrest characteristics did not differ between those who received a single shock versus multiple shocks except for duration of arrest and calendar year. The median first shock dose was consistent with AHA dosing recommendations and not different between those who received a single shock versus multiple shocks. Survival was improved for those who received a single shock compared to multiple shocks. However, no difference in survival was noted between those who received 2, 3, or ≥4 shocks. Of those receiving multiple shocks, no difference was observed with early dose escalation.ConclusionsIn pediatric IHCA, most patients with initial VF/pVT require more than one shock. No distinctions in patient or pre-arrest characteristics were identified between those who received a single shock versus multiple shocks. Subjects who received a single shock were more likely to survive to hospital discharge even after adjusting for duration of resuscitation.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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