Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest

for the pediRES-Q Investigators; James M. Gray; Tia T. Raymond; Dianne L. Atkins; Ken Tegtmeyer; Dana E. Niles; Vinay M. Nadkarni; Sandeep V. Pandit; Maya Dewan; Kamal Abulebda; Dianne Atkins; Shilpa Balikai; Marc Berg; Robert Berg; Utpal Bhalala; Matthew S. Braga; Corinne Buysse; Adam Cheng; Andrea Christoff; Kelly Corbett; Allan Decaen; Gabry Dejong; Jimena Del Castillo; Maya Dewan; Aaron Donoghue; Jordan Duval-Arnould; Ivie Esangbedo; Michael Flaherty; Maria Frazier; Stuart Friess; Sandeep Gangadharan; Orsola Gawronski; Jonathan Gilleland; Heather Griffis; James Gray; Helen Harvey; Ilana Harwayne-Gidansky; Sarah Haskell; Jennifer Hayes; Kiran Heber; Betsy Hunt; Takanari Ikeyama; Priti Jani; Katherine Daniels; Monica Kleinman; Lynda Knight; Hiroshi Kurosawa; Javier Lasa; Kasper Glerup Lauridsen; Tara Lemoine; Tensing Maa; Elizabeth Masse; Luz Marina Mejia; Michael Meyer; Yee Hui Mok; Ryan Morgan; Vinay Nadkarni; Sholeen Nett; Dana Niles; Amanda O'Halloran; Michelle Olson; Gene Ong; Prakad Rajapreyar; Tia Raymond; Joan Roberts; Anita Sen; Sophie Skellet; Daniel Stromberg; Felice Su; Robert Sutton; Todd Sweberg; Oscar Tegg; Ken Tegtmeyer; Alexis Topjian; Wendy Van Ittersum; Javier Urbano Villaescusa; Ichiro Watanabe; Denise Welsby; Jesse Wenger; Heather Wolfe; Andrea Yeo; Pricilla Yu

doi:10.1097/PCC.0000000000003241

Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest

for the pediRES-Q Investigators, James M. Gray, Tia T. Raymond, Dianne L. Atkins, Ken Tegtmeyer, Dana E. Niles, Vinay M. Nadkarni, Sandeep V. Pandit, Maya Dewan, Kamal Abulebda, Dianne Atkins, Shilpa Balikai, Marc Berg, Robert Berg, Utpal Bhalala, Matthew S. Braga, Corinne Buysse, Adam Cheng, Andrea Christoff, Kelly CorbettAllan Decaen, Gabry Dejong, Jimena Del Castillo, Maya Dewan, Aaron Donoghue, Jordan Duval-Arnould, Ivie Esangbedo, Michael Flaherty, Maria Frazier, Stuart Friess, Sandeep Gangadharan, Orsola Gawronski, Jonathan Gilleland, Heather Griffis, James Gray, Helen Harvey, Ilana Harwayne-Gidansky, Sarah Haskell, Jennifer Hayes, Kiran Heber, Betsy Hunt, Takanari Ikeyama, Priti Jani, Katherine Daniels, Monica Kleinman, Lynda Knight, Hiroshi Kurosawa, Javier Lasa, Kasper Glerup Lauridsen, Tara Lemoine, Tensing Maa, Elizabeth Masse, Luz Marina Mejia, Michael Meyer, Yee Hui Mok, Ryan Morgan, Vinay Nadkarni, Sholeen Nett, Dana Niles, Amanda O'Halloran, Michelle Olson, Gene Ong, Prakad Rajapreyar, Tia Raymond, Joan Roberts, Anita Sen, Sophie Skellet, Daniel Stromberg, Felice Su, Robert Sutton, Todd Sweberg, Oscar Tegg, Ken Tegtmeyer, Alexis Topjian, Wendy Van Ittersum, Javier Urbano Villaescusa, Ichiro Watanabe, Denise Welsby, Jesse Wenger, Heather Wolfe, Andrea Yeo, Pricilla Yu

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVES: To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA). DESIGN: Retrospective cohort study. SETTING: An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q]. PATIENTS: All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.

Original language	English
Pages (from-to)	E390-E396
Journal	Pediatric Critical Care Medicine
Volume	24
Issue number	8
DOIs	https://doi.org/10.1097/PCC.0000000000003241
State	Published - Aug 1 2023

Keywords

children
defibrillation
ventricular fibrillation
ventricular tachycardia

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10.1097/PCC.0000000000003241

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for the pediRES-Q Investigators, Gray, J. M., Raymond, T. T., Atkins, D. L., Tegtmeyer, K., Niles, D. E., Nadkarni, V. M., Pandit, S. V., Dewan, M., Abulebda, K., Atkins, D., Balikai, S., Berg, M., Berg, R., Bhalala, U., Braga, M. S., Buysse, C., Cheng, A., Christoff, A., ... Yu, P. (2023). Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest. Pediatric Critical Care Medicine, 24(8), E390-E396. https://doi.org/10.1097/PCC.0000000000003241

@article{012a853e43a948bd9233b71738726f54,

title = "Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest",

abstract = "OBJECTIVES: To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA). DESIGN: Retrospective cohort study. SETTING: An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q]. PATIENTS: All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.",

keywords = "children, defibrillation, ventricular fibrillation, ventricular tachycardia",

author = "{for the pediRES-Q Investigators} and Gray, {James M.} and Raymond, {Tia T.} and Atkins, {Dianne L.} and Ken Tegtmeyer and Niles, {Dana E.} and Nadkarni, {Vinay M.} and Pandit, {Sandeep V.} and Maya Dewan and Kamal Abulebda and Dianne Atkins and Shilpa Balikai and Marc Berg and Robert Berg and Utpal Bhalala and Braga, {Matthew S.} and Corinne Buysse and Adam Cheng and Andrea Christoff and Kelly Corbett and Allan Decaen and Gabry Dejong and Castillo, {Jimena Del} and Maya Dewan and Aaron Donoghue and Jordan Duval-Arnould and Ivie Esangbedo and Michael Flaherty and Maria Frazier and Stuart Friess and Sandeep Gangadharan and Orsola Gawronski and Jonathan Gilleland and Heather Griffis and James Gray and Helen Harvey and Ilana Harwayne-Gidansky and Sarah Haskell and Jennifer Hayes and Kiran Heber and Betsy Hunt and Takanari Ikeyama and Priti Jani and Katherine Daniels and Monica Kleinman and Lynda Knight and Hiroshi Kurosawa and Javier Lasa and Lauridsen, {Kasper Glerup} and Tara Lemoine and Tensing Maa and Elizabeth Masse and Mejia, {Luz Marina} and Michael Meyer and Mok, {Yee Hui} and Ryan Morgan and Vinay Nadkarni and Sholeen Nett and Dana Niles and Amanda O'Halloran and Michelle Olson and Gene Ong and Prakad Rajapreyar and Tia Raymond and Joan Roberts and Anita Sen and Sophie Skellet and Daniel Stromberg and Felice Su and Robert Sutton and Todd Sweberg and Oscar Tegg and Ken Tegtmeyer and Alexis Topjian and {Van Ittersum}, Wendy and Villaescusa, {Javier Urbano} and Ichiro Watanabe and Denise Welsby and Jesse Wenger and Heather Wolfe and Andrea Yeo and Pricilla Yu",

year = "2023",

month = aug,

day = "1",

doi = "10.1097/PCC.0000000000003241",

language = "English",

volume = "24",

pages = "E390--E396",

journal = "Pediatric Critical Care Medicine",

issn = "1529-7535",

number = "8",

}

for the pediRES-Q Investigators, Gray, JM, Raymond, TT, Atkins, DL, Tegtmeyer, K, Niles, DE, Nadkarni, VM, Pandit, SV, Dewan, M, Abulebda, K, Atkins, D, Balikai, S, Berg, M, Berg, R, Bhalala, U, Braga, MS, Buysse, C, Cheng, A, Christoff, A, Corbett, K, Decaen, A, Dejong, G, Castillo, JD, Dewan, M, Donoghue, A, Duval-Arnould, J, Esangbedo, I, Flaherty, M, Frazier, M, Friess, S, Gangadharan, S, Gawronski, O, Gilleland, J, Griffis, H, Gray, J, Harvey, H, Harwayne-Gidansky, I, Haskell, S, Hayes, J, Heber, K, Hunt, B, Ikeyama, T, Jani, P, Daniels, K, Kleinman, M, Knight, L, Kurosawa, H, Lasa, J, Lauridsen, KG, Lemoine, T, Maa, T, Masse, E, Mejia, LM, Meyer, M, Mok, YH, Morgan, R, Nadkarni, V, Nett, S, Niles, D, O'Halloran, A, Olson, M, Ong, G, Rajapreyar, P, Raymond, T, Roberts, J, Sen, A, Skellet, S, Stromberg, D, Su, F, Sutton, R, Sweberg, T, Tegg, O, Tegtmeyer, K, Topjian, A, Van Ittersum, W, Villaescusa, JU, Watanabe, I, Welsby, D, Wenger, J, Wolfe, H, Yeo, A & Yu, P 2023, 'Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest', Pediatric Critical Care Medicine, vol. 24, no. 8, pp. E390-E396. https://doi.org/10.1097/PCC.0000000000003241

TY - JOUR

T1 - Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest

AU - for the pediRES-Q Investigators

AU - Gray, James M.

AU - Raymond, Tia T.

AU - Atkins, Dianne L.

AU - Tegtmeyer, Ken

AU - Niles, Dana E.

AU - Nadkarni, Vinay M.

AU - Pandit, Sandeep V.

AU - Dewan, Maya

AU - Abulebda, Kamal

AU - Atkins, Dianne

AU - Balikai, Shilpa

AU - Berg, Marc

AU - Berg, Robert

AU - Bhalala, Utpal

AU - Braga, Matthew S.

AU - Buysse, Corinne

AU - Cheng, Adam

AU - Christoff, Andrea

AU - Corbett, Kelly

AU - Decaen, Allan

AU - Dejong, Gabry

AU - Castillo, Jimena Del

AU - Dewan, Maya

AU - Donoghue, Aaron

AU - Duval-Arnould, Jordan

AU - Esangbedo, Ivie

AU - Flaherty, Michael

AU - Frazier, Maria

AU - Friess, Stuart

AU - Gangadharan, Sandeep

AU - Gawronski, Orsola

AU - Gilleland, Jonathan

AU - Griffis, Heather

AU - Gray, James

AU - Harvey, Helen

AU - Harwayne-Gidansky, Ilana

AU - Haskell, Sarah

AU - Hayes, Jennifer

AU - Heber, Kiran

AU - Hunt, Betsy

AU - Ikeyama, Takanari

AU - Jani, Priti

AU - Daniels, Katherine

AU - Kleinman, Monica

AU - Knight, Lynda

AU - Kurosawa, Hiroshi

AU - Lasa, Javier

AU - Lauridsen, Kasper Glerup

AU - Lemoine, Tara

AU - Maa, Tensing

AU - Masse, Elizabeth

AU - Mejia, Luz Marina

AU - Meyer, Michael

AU - Mok, Yee Hui

AU - Morgan, Ryan

AU - Nadkarni, Vinay

AU - Nett, Sholeen

AU - Niles, Dana

AU - O'Halloran, Amanda

AU - Olson, Michelle

AU - Ong, Gene

AU - Rajapreyar, Prakad

AU - Raymond, Tia

AU - Roberts, Joan

AU - Sen, Anita

AU - Skellet, Sophie

AU - Stromberg, Daniel

AU - Su, Felice

AU - Sutton, Robert

AU - Sweberg, Todd

AU - Tegg, Oscar

AU - Tegtmeyer, Ken

AU - Topjian, Alexis

AU - Van Ittersum, Wendy

AU - Villaescusa, Javier Urbano

AU - Watanabe, Ichiro

AU - Welsby, Denise

AU - Wenger, Jesse

AU - Wolfe, Heather

AU - Yeo, Andrea

AU - Yu, Pricilla

PY - 2023/8/1

Y1 - 2023/8/1

N2 - OBJECTIVES: To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA). DESIGN: Retrospective cohort study. SETTING: An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q]. PATIENTS: All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.

AB - OBJECTIVES: To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA). DESIGN: Retrospective cohort study. SETTING: An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q]. PATIENTS: All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.

KW - children

KW - defibrillation

KW - ventricular fibrillation

KW - ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=85166442071&partnerID=8YFLogxK

U2 - 10.1097/PCC.0000000000003241

DO - 10.1097/PCC.0000000000003241

M3 - Article

C2 - 37115167

AN - SCOPUS:85166442071

SN - 1529-7535

VL - 24

SP - E390-E396

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

IS - 8

ER -

Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest

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Keywords

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