Nav: Home

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

May 31, 2006

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."
-end-
Co-authors of the study, in addition to Drs. Nadkarni, Meaney and Berg, were Ricardo A. Samson, M.D., and Marc D. Berg, M.D., of the University of Arizona; and Scott M. Carey of Digital Innovations, Bel Air, Md. Drs. Nadkarni and Meaney are also faculty members of the University of Pennsylvania School of Medicine. The Emergency Cardiovascular Care Committee of the AHA and the Endowed Chair of Pediatric Critical Care at The Children's Hospital of Philadelphia supported this study.

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

Children's Hospital of Philadelphia

Related Cardiac Arrest Articles:

Smartphone app directs first responders to cardiac arrest three minutes before ambulance
A novel smartphone application (app) has been developed that can direct first responders to cardiac arrest victims more than three minutes before the emergency services arrive.
Cardiac arrest on plane journeys: New guidelines proposed
New guidelines to deal with the in-flight emergency of cardiac arrest in a passenger or crew member are being proposed at this year's Euroanaesthesia meeting in Geneva (June 3-5).
Cardiac arrest patients do better if taken immediately to a specialist heart center
People who suffer cardiac arrest outside of hospital have a better chance of survival if they are taken immediately to a specialist heart center rather than to the nearest general hospital, according to research published in the European Heart Journal.
'Harmless' painkillers associated with increased risk of cardiac arrest
Painkillers considered harmless by the general public are associated with increased risk of cardiac arrest, according to research published today in the March issue of European Heart Journal - Cardiovascular Pharmacotherapy.
Two treatments yield similar outcomes in children after in-hospital cardiac arrest
Body cooling vs. active fever prevention: Emergency body cooling does not improve survival or functional outcomes in children who experience in-hospital cardiac arrest any more than normal temperature control.
Use of statins before cardiac arrest may aid survival afterwards
Patients who have been using cholesterol-lowering drugs known as statins fare better after a cardiac arrest than non-users.
CPR from bystanders associated with better outcomes after out-of-hospital cardiac arrest in pediatrics
Receiving cardiopulmonary resuscitation from a bystander -- compared with not -- was associated with better overall and neurologically favorable survival for children and adolescents who had out-of-hospital cardiac arrest, according to an article published online by JAMA Pediatrics.
AED accessibility a barrier during cardiac arrest
There's just a 1 in 5 chance that a potentially life-saving automated external defibrillator will be nearby when someone experiences cardiac arrest and a 20 to 30 percent chance that the nearby device will be inaccessible because it is inside a building that's closed, according to a study published today in the Journal of the American College of Cardiology.
Are we giving up on cardiac arrest patients too soon?
A University of Arizona study suggests physicians need to give comatose cardiac arrest survivors adequate time before predicting outcomes.
Gender gap found in cardiac arrest care, outcomes
Women treated at a hospital after cardiac arrest may be less likely than men to receive potentially life-saving procedures.

Related Cardiac Arrest Reading:

Cardiac Arrest: Five Heart-Stopping Years as a CEO On the Feds' Hit-List
by Howard Root (Author), Stephen Saltarelli (Author)

Who polices America’s prosecutors? And when they set their sights on an innocent CEO, can he survive a 5-year, $25 million legal labyrinth to save the company he built, and himself from prison? Howard Root started Vascular Solutions with little more than a dream and an idea for a single medical device. Fifteen years later, his Minnesota company had created over 500 American jobs and developed more than 50 new medical devices that saved and improved lives. But in 2011, the federal government threatened to destroy his company and put Howard behind bars for years. Why? Federal prosecutors had... View Details


Cardiac Arrest: The Science and Practice of Resuscitation Medicine, 2nd Edition
by Norman A. Paradis (Editor), Henry R. Halperin (Editor), Karl B. Kern (Editor), Volker Wenzel (Editor), Douglas A. Chamberlain (Editor)

Cardiac Arrest is the definitive and most comprehensive reference volume in advanced life support and resuscitation medicine. This new edition brings the reader completely up-to-date with developments in the field, focusing on practical issues of decision making, clinical management and prevention, as well as providing explanations of the science informing the practice. This volume is essential reading for all those involved in the emergency care of cardiac patients, either in the pre-hospital or hospital setting. View Details


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... View Details


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... View Details


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... View Details


Cardiac Arrest

"I could not stop reading ... compelling and moving" —Mike Weiss, Edgar Award winning author

A memoir about love, addiction, tragedy, and second chances.

On December 26th, 2010, author Wayne Heaney witnessed as his dad suddenly went from seemingly good health to fighting for his life on the living room floor. Nobody in the house was trained in CPR — an almost certain death sentence. Cardiac Arrest weaves the suspenseful tale of a special father-son relationship with the incident that threatened to tear it apart. View Details


Cardiac Arrest: The Science and Practice of Resuscitation Medicine
by Norman A., M.D. Paradis (Editor), Henry R., M.D. Halperin (Editor), Richard M. Nowak (Editor)

This volume on cardiac arrest focuses on the pathophysiology and therapy of sudden death. Topics covered include: the pathophysiology of global ischaemia and reperfusion; the therapy of sudden death; and social issues related to sudden death and man's attempt to reverse it. View Details


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... View Details


Therapeutic Hypothermia After Cardiac Arrest: Clinical Application and Management
by Justin B. Lundbye (Editor)

Therapeutic hypothermia has emerged as a very important treatment option for patients with cardiac arrest as it provides significant protection from developing neurologic injury once the patient has been successfully resuscitated. Studies have demonstrated over 15% absolute risk reduction in death and neurologic injury using this therapy. Although hospitals and medical centers have become familiar with this important intervention it still remains greatly under utilized due to an experience and lack of resources to safely and effectively deploy such a program. The objective of this book is to... View Details


Exploring Strategies to Improve Cardiac Arrest Survival: Proceedings of a Workshop
by Engineering, and Medicine National Academies of Sciences (Author), Health and Medicine Division (Author), Board on Population Health and Public Health Practice (Author), Andrea M. Schultz (Editor), Margaret A. McCoy (Editor)

Cardiac arrest often strikes seemingly healthy individuals without warning and without regard to age, gender, race, or health status. Representing the third leading cause of death in the United States, cardiac arrest is defined as “a severe malfunction or cessation of the electrical and mechanical activity of the heart ... [which] results in almost instantaneous loss of consciousness and collapseâ€. Although the exact number of cardiac arrests is unknown, conservative estimates suggest that approximately 600,000 individuals experience a cardiac arrest in the United States each... View Details

Best Science Podcasts 2017

We have hand picked the best science podcasts for 2017. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Simple Solutions
Sometimes, the best solutions to complex problems are simple. But simple doesn't always mean easy. This hour, TED speakers describe the innovation and hard work that goes into achieving simplicity. Guests include designer Mileha Soneji, chef Sam Kass, sleep researcher Wendy Troxel, public health advocate Myriam Sidibe, and engineer Amos Winter.
Now Playing: Science for the People

#448 Pavlov (Rebroadcast)
This week, we're learning about the life and work of a groundbreaking physiologist whose work on learning and instinct is familiar worldwide, and almost universally misunderstood. We'll spend the hour with Daniel Todes, Ph.D, Professor of History of Medicine at The Johns Hopkins University, discussing his book "Ivan Pavlov: A Russian Life in Science."