Subsequent shockable rhythm during out-of-hospital cardiac arrest in children with initial non-shockable rhythms: A nationwide population-based observational study

Background-the 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 results-from the all-japan utstein registry,we analyzed the records of 12 402 children (aged <18 years) with out-ofhospital 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. conclusions-in 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. © 2016 the authors.