Science Current Events | Science News |

When a child's heart stops, onset time of abnormal rhythms is crucial

June 01, 2006

Largest study of in-hospital cardiac arrest in children overturns conventional medical wisdom

Ventricular fibrillation, the life-threatening disordered heart rhythms that may accompany full cardiac arrest, occurs more frequently in children than commonly believed, according to a large national pediatric study.

Furthermore, not all ventricular fibrillation (VF) is the same, said study co-investigators Vinay Nadkarni, M.D., and Peter A. Meaney, M.D., M.P.H., specialists in Critical Care Medicine at The Children's Hospital of Philadelphia. They added that VF is more likely to be fatal if it is not the initial heart rhythm detected at the start of cardiac arrest, but instead develops later during the arrest, typically during resuscitation.

A research team from the American Heart Association's National Registry of Cardiopulmonary Resuscitation (CPR) analyzed records from more than 1,000 children who suffered cardiac arrests while in the hospital. The largest study by far of outcomes from VF in children, it appears in the June 1 issue of the New England Journal of Medicine. Researchers from Children's Hospital and from the University of Arizona led the study, which included records from 159 participating hospitals.

"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. "Abnormal rhythms were thought to be uncommon during cardiac arrests in children, occurring less than 10 percent of the time, but we found the occurrence to be 27 percent. When physicians applied shocks promptly from defibrillators, many of these children survived, and the vast majority of the survivors have good neurological outcomes."

"Secondly," continued Dr. Berg, "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."

Of the 1,005 children who suffered in-hospital cardiac arrest, more than one in four (272 patients) had documented VF or tachycardia (rapid heart beats) that require 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 percent survived to hospital discharge, compared to 11 percent 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 percent survived to hospital discharge.

The researchers were surprised that this group with no VF had better outcomes than children with subsequent VF. Unlike patients with VF, shock delivery with defibrillators does not help patients with asystole or pulseless rhythms.

The question of why survival outcomes from subsequent VF were so low is interesting and requires more research, according to the researchers. One possible explanation, said Dr. Berg, is that children with subsequent VF have more severe underlying heart disease. Another possibility is that clinicians are less aware of the possibility of subsequent VF, and may not diagnose and treat it until it is recognized very late in resuscitation efforts. If this is the case, he added, better recognition, diagnosis and treatment of subsequent VF might improve survival.

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.

Based partly on data reported by the National Registry of CPR, the American Heart Association recently issued new guidelines for CPR and emergency cardiovascular care, both for children and adults. "Our findings reinforce the concept that CPR with early recognition of shockable rhythms remains a most important aspect of successful cardiac resuscitation," added Dr. Nadkarni, "but clearly, we need to continue to develop, teach and implement better strategies using registries and networks that help us to discern key aspects of cardiac arrest."

Children's Hospital of Philadelphia

Related Cardiac Arrest Current Events and Cardiac Arrest News Articles

New guidance on preventing sudden cardiac death in athletes published
The Journal of the American College of Cardiology today published a consensus statement that establishes guidance for conducting pre-participation screenings of college athletes and encourages emergency action plans for quickly responding to sudden cardiac arrest.

Mixed results on benefits of antiarrhythmic drugs for out-of-hospital cardiac arrest
Paramedics often give heart rhythm stabilizing drugs to patients who are suffering out-of-hospital cardiac arrest when they fail to regain a stable heart rhythm after electrical shock treatment. In a study presented at the American College of Cardiology's 65th Annual Scientific Session, these drugs, specifically amiodarone and lidocaine, did not significantly improve such patients' likelihood of surviving to hospital discharge overall.

New study: Waist circumference is stronger predictor of heart disease than BMI
A new study from the Intermountain Medical Center Heart Institute in Salt Lake City and John Hopkins Hospital in Baltimore lends more evidence to the idea that it's better to be shaped like a pear -- with weight around the hips -- as opposed to an apple -- with weight around the abdomen.

Long-term exposure to ozone may increase lung and cardiovascular deaths
Adults with long-term exposure to ozone (O3) face an increased risk of dying from respiratory and cardiovascular diseases, according to the study "Long-Term Ozone Exposure and Mortality in a Large Prospective Study" published online ahead of print in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Cardiac arrests in high-rise buildings: Low survival rates above 3rd floor
Residents of high-rise buildings had better survival rates from cardiac arrests if they lived on the first few floors, and survival was negligible for people living above the 16th floor, according to a study published in CMAJ (Canadian Medical Association Journal)

Chronic traumatic encephalopathy in 25-year-old former football player
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impacts and can be diagnosed only by autopsy after death.

Novel peptide enhances natural mechanism to protect brain cells following cardiac arrest
A novel peptide appears to enhance a natural mechanism for protecting stressed brain cells and improve cognitive function following cardiac arrest, scientists report.

Seizure risk of anti-shivering agent meperidine greatly overstated
Meperidine, an opioid analgesic commonly used to control shivering in accidental or therapeutic hypothermia, has been linked to increased seizure risk, but a new study finds little published evidence to support this risk.

Ranibizumab found effective against diabetic retinopathy
In a randomized clinical trial of more than 300 participants, researchers from Johns Hopkins and elsewhere have found that ranibizumab -- a drug most commonly used to treat retinal swelling in people with diabetes -- is an effective alternative to laser therapy for treating the most severe, potentially blinding form of diabetic retinal disease.

Study quantifies risk of cardiac arrest in children during spine surgeries
Although the vast majority of pediatric spine surgeries are safe, a handful of neuromuscular conditions seem to fuel the risk of cardiac arrest during such operations, according to research led by investigators at the Johns Hopkins Children's Center.
More Cardiac Arrest Current Events and Cardiac Arrest News Articles

Cardiac Arrest (The Ladies Smythe & Westin)

Cardiac Arrest (The Ladies Smythe & Westin)
by Carina Press

A clueless twentysomething party girl and a feisty senior form a most unlikely sleuthing duo in the first book of a quirky mystery series from Lisa Q. Mathews.

When a man falls at your feet, you'd better hope he's not dead.

Twentysomething party girl Summer Smythe is starting over in the unlikeliest of places; Hibiscus Pointe, a kitschy retirement community inÿupscale Milano, Florida. Her new gig? Working for Dr. A, Milano's much-loved cardiologist. But being in over her head is the least of Summer's worries when her new boss drops dead…right in front of her.

Longtime resident Dorothy Westin prefers to mind her own business. But when the young blonde already causing ripples throughout Hibiscus Pointe becomes a person of interest in Dr. A's murder, Dorothy...

Love Like There's No Tomorrow: How a Cardiac Arrest Brought My Heart to Life

Love Like There's No Tomorrow: How a Cardiac Arrest Brought My Heart to Life
by Ocieanna Fleiss (Author)

A few years ago, Ocieanna Fleiss—wife and work-at-home mother of four young children—would have described herself as overwhelmed, stressed, and focused on finishing her to-do list. But when at age forty-two, a sudden cardiac arrest stopped her heart, everything changed.

During those quiet months of recovery, as she reflected on her life, a pattern arose. Like a loving father, Christ had always walked with her—through childhood neglect, miscarriages, the death of her parents, and even through her own death!

Amazed by God’s loving hand in her life, Ocieanna overflowed with a desire to love in a new, more profound way. Out of this desire, transforming truths gently came to light: truths that changed her life forever and will show you how God can weave everything in...

Cardiac Arrest: A Farrah Wethers Mystery (Book 1) (Farrah Wethers Mysteries) (Volume 1)

Cardiac Arrest: A Farrah Wethers Mystery (Book 1) (Farrah Wethers Mysteries) (Volume 1)
by Ms. Elizabeth-Amber Love (Author)

Farrah Wethers lost her office job and embarked on a career as a new massage therapist in suburban New Jersey where she lives with her husband Jackson. Farrah and her best friend June Cho navigate the murder mystery of a well-respected and wealthy client of Riverside Wellness Spa. Because the philandering Mr. Koczak died in the closed room at the spa while Farrah was working on him, she becomes the prime suspect. Farrah is befriended by the widow who invites Farrah and June to the lavish memorial festivities honoring her husband which gives them opportunities to find a slate of suspects and clues.

Cardiac Arrest - A Reference Guide (BONUS DOWNLOADS) (The Hill Resource and Reference Guide Book 90)

Cardiac Arrest - A Reference Guide (BONUS DOWNLOADS) (The Hill Resource and Reference Guide Book 90)
by Capitol Hill Press

18 Health and Disease Professional Textbooks (over 5,300 pages) For Your E-Reader
* BONUS Encyclopedia of Disease (14 volumes, 4,625 pages)
* BONUS Dictionary of Clinical Research Terms (268 pages)
* BONUS Dictionary of Psychiatry Terminology (167 pages)
* BONUS The Complete Guide to Alternative and Complementary Medicine (135 pages)
* BONUS The Truth About Herbal Cures (106 pages)

Series Description
Note: For best results and the most comprehensive reading and research experience, please use book in conjunction with the bonus downloads.

The Hill Resource and Reference Guide series is a comprehensive and authoritative source of quality health research sources for both the layperson and medical health...

The Silent Heart: A Personal Journey Back from Cardiac Arrest

The Silent Heart: A Personal Journey Back from Cardiac Arrest
by Larry J. Matthews (Author)

Every year, hundreds of thousands of Americans survive heart attacks. The journey back to a normal life is not always easy. In THE SILENT HEART, author Larry J. Matthews provides a road map of the physical and emotional obstacles encountered on his personal journey through the ten months following his heart attack and cardiac arrest. In this memoir, Matthews offers an intimate look into the mind of a heart attack survivor, sharing the events and his thoughts and feelings after his heart stopped beating. Combining personal experience with medical facts and reflections from his family, THE SILENT HEART shows the realities of heart disease, heart attacks, and rehabilitation as they affect not only the patient, but loved ones as well. THE SILENT HEART gives hope and encouragement to those...

Cardiac Arrest

Cardiac Arrest

Ella Marley's world is shattered when a botched robbery costs her beloved older brother his life. She must try to move on while enduring a murder investigation that twists her emotions.
Detective Cory McCray couldn't help but be drawn to her the first time he set eyes on her in the hospital. He struggles to keep his feelings in check - he has a case to solve. But as the pieces come together, he wonders where she fits in - and if he is thinking with his head or his heart.
Cardiac Arrest is a quick, romantic read with a touch of mystery.

Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death

Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death
by Sam Parnia (Author), Josh Young (Author)

Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death reveals that death is not a moment in time. Death, rather, is a process—a process that can be interrupted well after it has begun. Innovative techniques have proven to be effective in revitalizing both the body and mind, but they are only employed in approximately half of the hospitals throughout the United States and Europe.
Dr. Sam Parnia, Director of the AWARE Study (AWAreness during REsuscitation) and one of the world’s leading experts on the scientific study of death and near-death experiences (NDE), presents cutting-edge research from the front lines of critical care and resuscitation medicine while also shedding light on the ultimate mystery: What happens to human consciousness...

Resuscitate!: How Your Community Can Improve Survival from Sudden Cardiac Arrest (Samuel and Althea Stroum Book (Paperback))

Resuscitate!: How Your Community Can Improve Survival from Sudden Cardiac Arrest (Samuel and Althea Stroum Book (Paperback))
by Mickey S. Eisenberg M.D. (Author)

Sudden cardiac arrest is the leading cause of death among adults, yet it need not be fatal. Though survival in most communities is very poor, a few communities achieve rates as high as 50%. Why are some communities so successful in snatching life from the jaws of death? Resuscitate! describes the steps any EMS system can take to improve cardiac arrest survival. It is written for the medical directors, administrative directors, fire chiefs, dispatch directors, and program supervisor who direct and run EMS systems all across the country, and for the EMTs, paramedics, and dispatchers who provide frontline care.

This second edition of Resuscitate! provides fifteen concrete steps to improve survival. Four steps will lead to rapid improvements at the local level and are relatively easy...

Cardiac Arrest (A Short Story)

Cardiac Arrest (A Short Story)

Cardiac Arrest (A Short Story)
By K.K. Chalmers

What happens when a cop can't escape the pressures of the job?
A short story of psychological suspense.
(3,260 words)

ACLS Certification Exam Q&A With Explanations

ACLS Certification Exam Q&A With Explanations
by Michele G. Kunz (Author), Jr. Joseph C. Kunz (Author), Peter Woods (Foreword)

ACLS Certification Exam Q&A With Explanations will certainly help you pass any Advance Life Support Certification Course. As you look through the book, you will quickly see that this book's format is different from all other review and test preparation books. This book is specifically geared toward healthcare students and new healthcare professionals that are preparing to take the ACLS certification exam for the first time. This book will also give the seasoned healthcare professional lots of great review information as well as a way to update themselves on the latest research and guidelines. Whichever certifying agency's program you are taking, either in a classroom or on the internet, this book and its contents will help you succeed in this course. In this book we give you all the...

© 2016