McCartney B, Harvey A, Kernaghan A, Morais S, McAlister O, Crawford P, Biglarbeigi P, Bond R, Finlay D, McEneaney D. Pediatric defibrillation shocks alone do not cause heart damage in a porcine model.
Resusc Plus 2022;
9:100203. [PMID:
35146463 PMCID:
PMC8816722 DOI:
10.1016/j.resplu.2022.100203]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
AEDs utilize specific low energy pediatric modes to reduce myocardial damage.
This study applied various shocks in sinus rhythm without cardiac instrumentation.
Isolated clinically relevant shock sequences do not result in myocardial damage.
Typical variations in pediatric shocks did not affect safety and efficacy.
These results may inform future pediatric resuscitation guidelines.
Aim
Automated external defibrillators (AEDs) use various shock protocols with different characteristics when deployed in pediatric mode. The aim of this study is to assess and compare the safety and efficacy of different AED pediatric protocols using novel experimental approaches.
Methods
Two defibrillation protocols (A and B) were assessed across two studies: Protocol A: escalating (50–75–90 J) defibrillation waveform with higher voltage, shorter duration and equal phase durations. Protocol B; non-escalating (50–50–50 J) defibrillation waveform with lower voltage, longer duration and unequal phase durations.
Experiment 1: Isolated shock damage was assessed following shocks to 12 anesthetized pigs. Animals were randomized into two groups, receiving three shocks from Protocol A (50–75–90 J) or B (50–50–50 J). Cardiac function, cardiac troponin I (cTnI), creatine phosphokinase (CPK) and histopathology were analyzed. Experiment 2: Defibrillation safety and efficacy were assessed through shock success, ROSC, ST-segment deviation and contractility following 16 randomized shocks from protocol A or B delivered to 10 anesthetized pigs in VF.
Results
Experiment 1: No clinically meaningful difference in cTnI, CPK, ST-segment deviation, ejection fraction or histopathological damage was observed following defibrillation with either protocol. No difference was observed between protocols at any timepoint. Experiment 2: all defibrillation types demonstrated shock success and ROSC ≥ 97.5%. Post-ROSC contractility was similar between protocols.
Conclusions
There is no evidence that administration of clinically relevant shock sequences, without experimental confounders, result in significant myocardial damage in this model of pediatric resuscitation. Typical variations in AED pediatric mode settings do not affect defibrillation safety and efficacy.
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