Subsequent Shockable Rhythm During Out-of-Hospital Cardiac Arrest in Children With Initial Non-Shockable Rhythms: A Nationwide Population-Based Observational Study.

Abstract

BackgroundThe effect of a subsequent treated shockable rhythm during cardiopulmonary resuscitation on the outcome of children who suffer out‐of‐hospital cardiac arrest with initial nonshockable rhythm is unclear. We hypothesized that subsequent treated shockable rhythm in children with out‐of‐hospital cardiac arrest would improve survival with favorable neurological outcomes (Cerebral Performance Category scale 1–2).Methods and ResultsFrom the All‐Japan Utstein Registry, we analyzed the records of 12 402 children (aged <18 years) with out‐of‐hospital cardiac arrest and initial nonshockable rhythms. Patients were divided into 2 cohorts: subsequent treated shockable rhythm (YES; n=239) and subsequent treated shockable rhythm (NO; n=12 163). The rate of 1‐month cerebral performance category 1 to 2 in the subsequent treated shockable rhythm (YES) cohort was significantly higher when compared to the subsequent treated shockable rhythm (NO) cohort (4.6% [11 of 239] vs 1.3% [155 of 12 163]; adjusted odds ratio, 2.90; 95% CI, 1.42–5.36; all P<0.001). In the subsequent treated shockable rhythm (YES) cohort, the rate of 1‐month cerebral performance category 1 to 2 decreased significantly as time to shock delivery increased (17.7% [3 of 17] for patients with shock‐delivery time 0–9 minutes, 7.3% [8 of 109] for 10–19 minutes, and 0% [0 of 109] for 20–59 minutes; P<0.001 [for trend]). Age‐stratified outcomes showed no significant differences between the 2 cohorts in the group aged <7 years old: 1.3% versus 1.4%, P=0.62.ConclusionsIn children with out‐of‐hospital cardiac arrest and initial nonshockable rhythms, subsequent treated shockable rhythm was associated with improved 1‐month survival with favorable neurological outcomes. In the cohort of older children (7–17 years), these outcomes worsened as time to shock delivery increased.