Abstract 18326: The Association of s Shockable Rhythm and Automated External Defibrillator Use With Outcomes in Infants With Out of Hospital Cardiac Arrest: A Study From the Cardiac Arrest Registry to Enhance Survival

Abstract

Introduction: Defibrillation with an automated external defibrillator (AED) is critical in the chain of survival following a cardiac arrest caused by pulseless ventricular tachycardia and ventricular fibrillation. However, in 2022 the International Liaison Committee on Resuscitation could not make a recommendation for or against the use of AEDs in infants. Hypothesis: We aimed to describe the association of a shockable rhythm with outcomes in infants with out of hospital cardiac arrest (OHCA) and test the hypothesis that a shockable rhythm and AED use with defibrillation would be associated with improved neurologically favorable survival at hospital discharge by analyzing data from a large cardiac arrest registry in the United States Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age < 1 year of age and non-traumatic OHCA from January 1, 2013 through December 31, 2021. The primary outcome was neurologically favorable survival defined as a Cerebral Performance Category Scale of 1 or 2. Results: A total of 10,108 infants with OHCA were evaluated of which 308 (3%) had a shockable rhythm and 9,800 (97%) had a non-shockable rhythm. Compared to infants with non-shockable rhythms infants with shockable rhythms were more likely to be white (37.7% white, 25.6% black, 7.5% Hispanic), have a witnessed arrest (44.5% vs. 16%), a non-home/public arrest (16.9% vs. 6.7%), and bystander AED application with defibrillation (19.4% vs. 0.18%) (p<0.05 for all). Neurologically favorable survival (19.2% shockable vs. 4.2% non-shockable was higher in arrests with a shockable rhythm compared to non-shockable arrests, p<0.001). AEDs were applied by bystanders in 1479 (14.5%) arrests and were associated with neurologically favorable survival (11% AED with defibrillation vs. 3.5% AED without defibrillation, p=0.002) Conclusions: Although infants infrequently had an OHCA with a shockable rhythm survival outcomes were superior in arrests with a shockable rhythm and in arrests where there was bystander AED use with defibrillation. These results emphasize the importance of AED use in infants with shockable rhythms following an OHCA.