Department of Pediatrics, University of Cincinnati, Cincinnati, OH.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Crit Care Med. 2023 Aug 1;24(8):e390-e396. doi: 10.1097/PCC.0000000000003241. Epub 2023 Apr 28.
To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA).
Retrospective cohort study.
An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q].
All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available.
None.
We analyzed 418 shocks delivered during 159 cardiac arrest events, with 381 shocks during 158 events at 28 sites remaining after excluding undecipherable rhythms. We classified shocks as: 1) appropriate (ventricular fibrillation [VF] or wide complex ≥ 150/min); 2) indeterminate (narrow complex ≥ 150/min or wide complex 100-149/min); or 3) inappropriate (asystole, sinus, narrow complex < 150/min, or wide complex < 100/min) based on the rhythm immediately preceding shock delivery. Of delivered shocks, 57% were delivered appropriately for VF or wide complex rhythms with a rate greater than or equal to 150/min. Thirteen percent were classified as indeterminate. Thirty percent were delivered inappropriately for asystole (6.8%), sinus (3.1%), narrow complex less than 150/min (11%), or wide complex less than 100/min (8.9%) rhythms. Eighty-eight percent of all shocks were delivered in ICUs or emergency departments, and 30% of those were delivered inappropriately.
The rate of inappropriate shock delivery for pediatric IHCA in this international cohort is at least 30%, with 23% delivered to an organized electrical rhythm, identifying opportunity for improvement in rhythm identification training.
描述儿科院内心搏骤停（IHCA）期间不适当的电击治疗。
回顾性队列研究。
国际儿科心脏骤停质量改进合作组织儿科复苏质量[pedires-q]。
来自 pedires-q 合作组织的 2015 年至 2020 年所有 IHCA 事件，这些事件均有电击和心电图波形数据。
无。
我们分析了 418 次在 159 次心脏骤停事件中给予的电击，在排除无法解读的节律后，28 个地点的 158 次事件中有 381 次电击。我们将电击分为：1）适当（心室颤动[VF]或宽复合波≥150/min）；2）不确定（窄复合波≥150/min 或宽复合波 100-149/min）；或 3）不适当（停搏、窦性、窄复合波<150/min 或宽复合波<100/min），根据电击前的即时节律进行分类。在给予的电击中，57%是为 VF 或宽复合波≥150/min 的节律而给予的适当电击。13%被归类为不确定。30%是为停搏（6.8%）、窦性（3.1%）、窄复合波<150/min（11%）或宽复合波<100/min（8.9%）而给予的不适当电击。88%的电击都在 ICU 或急诊室进行，其中 30%是不适当的。
在这个国际队列中，儿科 IHCA 不适当电击治疗的发生率至少为 30%，其中 23%是为有组织的电节律而给予的，这表明在节律识别培训方面有改进的空间。
