Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in JapanReport as inadecuate




Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in Japan - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 16:R219

First Online: 13 November 2012Received: 10 September 2012Revised: 31 October 2012Accepted: 09 November 2012

Abstract

IntroductionConventional monophasic defibrillators for out-of-hospital cardiac-arrest patients have been replaced with biphasic defibrillators. However, the advantage of biphasic over monophasic defibrillation for pediatric out-of-hospital cardiac-arrest patients remains unknown. This study aimed to compare the survival outcomes of pediatric out-of-hospital cardiac-arrest patients who underwent monophasic defibrillation with those who underwent biphasic defibrillation.

MethodsThis prospective, nationwide, population-based observational study included pediatric out-of-hospital cardiac-arrest patients from January 1, 2005, to December 31, 2009. The primary outcome measure was survival at 1 month with minimal neurologic impairment. The secondary outcome measures were survival at 1 month and the return of spontaneous circulation before hospital arrival. Multivariable logistic regression analysis was performed to identify the independent association between defibrillator type monophasic or biphasic and outcomes.

ResultsAmong 5,628 pediatric out-of-hospital cardiac-arrest patients 1 through 17 years old, 430 who received defibrillation shock with monophasic or biphasic defibrillator were analyzed. The number of patients who received defibrillation shock with monophasic defibrillator was 127 30%, and 303 70% received defibrillation shock with biphasic defibrillator. The survival rates at 1 month with minimal neurologic impairment were 17.5% and 24.4%, the survival rates at 1 month were 32.3% and 35.6%, and the rates of return of spontaneous circulation before hospital arrival were 24.4% and 27.4% in the monophasic and biphasic defibrillator groups, respectively. Hierarchic logistic regression analyses by using generalized estimation equations found no significant difference between the two groups in terms of 1-month survival with minimal neurologic impairment odds ratio OR, 1.57; 95% confidence interval CI, 0.87 to 2.83; P = 0.14 and 1-month survival OR, 1.38; 95% CI, 0.87 to 2.18; P = 0.17.

ConclusionsThe present nationwide population-based observational study could not confirm an advantage of biphasic over monophasic defibrillators for pediatric OHCA patients.

AbbreviationsAEDautomated external defibrillator

CPCcerebral performance category

CPRcardiopulmonary resuscitation

EMSemergency medical service

FDMAFire and Disaster Management Agency of Japan

GEEgeneralized estimation equation

OHCAout-of-hospital cardiac arrest

ORodds ratio

ROSCreturn of spontaneous circulation

VFventricular fibrillation.

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Author: Seizan Tanabe - Hideo Yasunaga - Soichi Koike - Manabu Akahane - Toshio Ogawa - Hiromasa Horiguchi - Tetsuo Hatanaka - Hiro

Source: https://link.springer.com/







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