Arrythmia Dangerous in Children With Cardiac Arrest

Ventricular fibrillation (VF) occurs more frequently in children than commonly believed, and the onset time of the abnormal rhythms is crucial, according to a new pediatric study.

A research team from the American Heart Association's (AHA) national registry of cardiopulmonary resuscitation (CPR) analyzed records of more than 1,000 children who suffered cardiac arrests while hospitalized. Of the 1,005 children who suffered in-hospital cardiac arrest, 272 patients had documented VF or tachycardia (rapid heart beats) that required shocks at some point during the arrest. In 104 of those patients, VF or tachycardia occurred initially, while in 149 patients it occurred at a subsequent time during the arrest. Of the children with initial abnormal rhythms, 35% survived to hospital discharge, compared to 11% of children with subsequent abnormal rhythms.

The largest group of patients with cardiac arrest, 733 children, had no documented VF or tachycardia. A majority of the group, 602 patients, was known to have asystole (no heart contractions) or no pulse at the start of cardiac arrest. This group had intermediate outcomes: 27% survived to hospital discharge. These findings were published in the June 1, 2006, issue of the New England Journal of Medicine

"This landmark in-hospital study challenges prevailing paradigms in pediatric cardiac critical care,” said senior author Robert A. Berg, M.D., of the Steele Children's Research Center at the University of Arizona (Tucson, USA). "We learned that cardiac arrests due to initial shockable rhythms often have good outcomes, whereas cardiac arrests with shockable rhythms developing during resuscitation typically have poor outcomes. Now we have to learn what we can do to improve outcomes from the latter cases.”

The authors point out that, although outcomes may vary, the majority of children with cardiac arrest do not survive to hospital discharge. However, they stress that CPR and advanced life support are certainly not futile, even among the group with the worst outcomes--children with subsequent VF and tachycardia.



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