Abstract
Objective
To evaluate the efficacy and safety of defibrillation on children according to AHA 2005 recommendations
Methods
Pig resembles human in the chest configuration, anatomy and physiology of the cardiovascular and pulmonary systems. Piglets weighing 7.0 Kg ± 1.4kg, 14.0kg ± 2.8kg, 25.0kg ± 5.0kg respectively, which represented children 1 to 8 yr old were induced ventricular fibrillation (VF). An adult biphasic AED was used in conjunction with pediatric attenuating electrodes which could deliver 50-J shock for 2 min and two min of cardiopulmonary resuscitation (CPR) immediately followed it. If VF did not reverse, 70-J shock combined with CPR was used, and the protocol was repeated five times. If an organized cardiac rhythm with mean aortic pressure more than 60 mmHg persisted for an interval of 5 minutes, the animal was regarded as successfully resuscitated. If the AED recognized a “non-shockable” rhythm, CPR was also performed immediately for 2 min. The same resuscitation program was exercised on piglets of manual defibrillator group. Neurologic alertness score, hemodynamic and myocardial functions were evaluated, autopsy was routinely performed to document possible injuries.
Results
In the AED group, 14 out of 15 animals, were successfully resuscitated, among them 11 piglets were resuscitated by 50-J defibrillation combined with cardiopulmonary resuscitation, and other three recovered to normal by 1 or 2 times of 70-J shocks and CPR. All animals in manual defibrillator group were successfully resuscitated by 50-J shocks and CPR. Left ventricular ejection fraction and fractional area change were reduced significantly during 3–4 hr post-resuscitation (P<0.05) and returned to baseline ranges at the end of 72 hr. There was no evidence of myocardial and pulmonary damage during autopsy, and neurologic recovery was also normal. Data of blood gas analysis, blood electrolytes and myocardial enzymes does not show any statistically significant difference (P> 0.05) in the groups. 50 J biphasic dose defibrillation combined with effective CPR, successfully terminated VF without adverse effects on myocardial function and survival in a piglet defibrillation model for young children 1 to 8 yr of age.
Conclusions
The new guidelines recommendation that one shock immediately followed by CPR is reasonable. Adults AED combined with pediatric electrodes is feasible to the diagnosis and treatment of pediatric VF model. But the user should not rely too much on AED’s “automatic” function, but should accumulate and integrate his experience with AED technology.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Berg MD, Nadkarni VM, Berg RA. Cardiopulmonary resuscitation in children. Curr Opin Crit Care 2008; 14: 254–260.
Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 2004; 114: 157–164.
Berg MD, Samson RA, Meyer RJ, Clark LL, Valenzuela TD, Berg RA. Pediatric defibrillation doses often fail to terminate prolonged out-of-hospital ventricular fibrillation in children. Resuscitation 2005; 67: 63–67.
Markenson D, Pyles L, Neish S, the Committtee on Pediatric Emergency Medicine and Section on Cardiology and Cardiac Surgey Ventricular Fibrillation and the Use of Automated External Defibrillators on Children. Pediatrics 2007; 120: 1368–1379.
Smith BT, Rea TD, Eisenberg MS. Ventricular fibrillation in pediatric cardiac arrest. Acad Emerg Med 2006; 13: 525–529.
2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Part 6: pediatric basic and advanced life support. Circulation 2005;112(22 Suppl): III73–III90.
Yonghua Xu, Xingyi Yang. Biphasic waveform Automated External Defibrillator. China Emergency Medicine 2003; 23: 569–570.
Hancock HC, Roebuck A, Farrer M, Campbell S. Fully automatic external defibrillators in acute care: clinicians’experiences and perceptions. Eur J Cardiovasc Nurs 2006; 5: 214–221.
Tang W, Weil MH, Jorgenson D et al. Fixed-energy biphasic waveform defibrillation in a pediatric model of cardiac arrest and resuscitation. Crit Care Med 2002; 30: 2736–2741.
Zhang Y, Clark CB, Davies LR, Karlsson G, Zimmerman MB, Kerber R. Body weight is a predictor of biphasic shock success for low energy transthoracic defibillation. Resuscitation 2002; 54: 281–287.
Berg MD, Banville IL, Chapman FW et al. Attenuating the defibrillation dosage decreases postresuscitation myocardial dysfunction in a swine model of pediatric ventricular fibrillation. Pediatr Crit Care Med 2008; 9: 429–434.
Xunmei Fan 2005. AHA cardiopulmonary resuscitation and emergency cardiovascular application of the guidelines in pediatrics thinking. Clin J Pediatr 2007; 25: 888–945.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhou, Z., Wang, Y., Zhou, H. et al. Defibrillation and resuscitation in a piglet model of pediatric ventricular fibrillation following AHA 2005 guidelines. Indian J Pediatr 77, 893–897 (2010). https://doi.org/10.1007/s12098-010-0128-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-010-0128-8