© 2020 Published by Elsevier B.V.

Resuscitation 153 (2020) 88-96


Received: 12 January 2020 / Accepted: 26 May 2020


Improved survival to hospital discharge in pediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia



Derek B Hoyme, Yunshu Zhou, Saket Girotra, Sarah E Haskell, Ricardo A Samson, Peter Meaney, Marc Berg, Vinay M Nadkarni,

Robert A Berg, Mary Fran Hazinski, Javier J Lasa, Dianne L Atkins



Email: dhoyme@wisc.edu (D.B. Hoyme)



The American Heart Association (AHA) recommends first defibrillation energy dose of 2Joules/kilogram (J/kg) for pediatric cardiac arrest with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). However, optimal first energy dose remains unclear.



Using AHA Get With the Guidelines-Resuscitation® (GWTG-R) database, we identified children ≤12 years with IHCA due to VF/pVT. Primary exposure was energy dose in J/kg. We categorized energy doses: 1.7–2.5J/kg as reference (reflecting 2J/kg intended dose), <1.7J/kg and >2.5J/kg. We compared survival for reference doses to all other doses. We constructed models to test association of energy dose with survival; adjusting for age, location, illness category, initial rhythm and vasoactive medications.



We identified 301 patients ≤12 years with index IHCA and initial VF/pVT. Survival to discharge was significantly lower with energy doses other than 1.7–2.5J/kg. Individual dose categories of <1.7J/kg or >2.5J/kg were not associated with differences in survival. For patients with initial VF, doses >2.5J/kg had worse survival compared to reference. For all patients 18 years (n=422), there were no differences in survival between dosing categories. However, all ≤18 with initial VF receiving >2.5J/kg had worse survival.



First energy doses other than 1.7–2.5J/kg are associated with lower rate of survival to hospital discharge in patients 12 years old with initial VF/pVT, and first doses >2.5J/kg had lower survival rates in all patients ≤18 years old with initial VF. These results support current AHA guidelines for first pediatric defibrillation energy dose of 2J/kg.


Full Article Text