Department of Anesthesiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Pediatrics. 2011 Jan;127(1):e16-23. doi: 10.1542/peds.2010-1617. Epub 2010 Dec 20.
To examine the effectiveness of initial defibrillation attempts. We hypothesized that (1) an initial shock dose of 2 ± 10 J/kg would be less effective for terminating fibrillation than suggested in published historical data and (2) a 4 J/kg shock dose would be more effective.
This was a National Registry of Cardiopulmonary Resuscitation prospective, multisite, observational study of in-hospital pediatric (aged ≤18 years) ventricular fibrillation or pulseless ventricular tachycardia cardiac arrests from 2000-2008. Termination of ventricular fibrillation or pulseless ventricular tachycardia and event survival after initial shocks of 2 J/kg were compared with historic controls and a 4 J/kg shock dose.
Of 266 children with 285 events, 173 of 285 (61%) survived the event and 61 of 266 (23%) survived to discharge. Termination of fibrillation after initial shock was achieved for 152 of 285 (53%) events. Termination of fibrillation with 2 ± 10 J/kg was much less frequent than that seen among historic control subjects (56% vs 91%; P < .001), but not different than 4 J/kg. Compared with 2 J/kg, an initial shock dose of 4 J/kg was associated with lower rates of return of spontaneous circulation (odds ratio: 0.41 [95% confidence interval: 0.21-0.81]) and event survival (odds ratio: 0.42 [95% confidence interval: 0.18-0.98]).
The currently recommended 2 J/kg initial shock dose for in-hospital cardiac arrest was substantially less effective than previously published. A higher initial shock dose (4 J/kg) was not associated with superior termination of ventricular fibrillation or pulseless ventricular tachycardia or improved survival rates. The optimal pediatric defibrillation dose remains unknown.
研究初始除颤尝试的效果。我们假设：(1) 初始电击剂量为 2 ± 10 J/kg 比已发表的历史数据中建议的剂量更难终止纤颤；(2) 4 J/kg 的电击剂量会更有效。
这是一项全国心肺复苏注册处前瞻性、多地点、观察性研究，纳入 2000-2008 年期间院内发生的小儿（年龄≤18 岁）心室纤颤或无脉性室性心动过速心脏骤停患者。将 2 J/kg 初始电击剂量后的室颤或无脉性室速终止情况与历史对照和 4 J/kg 电击剂量进行比较。
在 266 例儿童的 285 次事件中，173 例（61%）在事件中存活，266 例（23%）存活至出院。285 次事件中，有 152 次（53%）初始电击后终止纤颤。2 ± 10 J/kg 时的纤颤终止率明显低于历史对照（56% vs 91%；P <.001），但与 4 J/kg 相似。与 2 J/kg 相比，4 J/kg 的初始电击剂量与自主循环恢复率（比值比：0.41 [95%置信区间：0.21-0.81]）和事件存活率（比值比：0.42 [95%置信区间：0.18-0.98]）降低相关。
目前推荐的院内心脏骤停初始 2 J/kg 电击剂量明显不如以往发表的剂量有效。较高的初始电击剂量（4 J/kg）与终止室颤或无脉性室速或提高生存率无关。最佳的儿科除颤剂量仍未知。
