What are the percentages of presenting rhythms in pediatric cardiac arrest?

From the Guidelines

In pediatric cardiac arrest, asystole is the most common presenting rhythm, occurring in approximately 40% of cases, followed by pulseless electrical activity (PEA) in about 24% of cases, and ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) in around 14% of cases. The distribution of these rhythms is based on data from a 2013 study published in Circulation, which analyzed the first documented rhythm in pediatric and adult cardiac arrests 1. According to this study, the percentages of presenting rhythms in pediatric cardiac arrest are:

• Asystole: 40% (350 out of 880 cases)
• VF or pulseless VT: 14% (120 out of 880 cases)
• PEA: 24% (213 out of 880 cases)
• Unknown by documentation: 22% (197 out of 880 cases)

These percentages are significant because they impact survival outcomes, with VF/pVT generally having a better prognosis than asystole or PEA when appropriate interventions are promptly delivered 1. Understanding the distribution of presenting rhythms in pediatric cardiac arrest is crucial for appropriate resuscitation preparation and can help improve survival rates. The fact that asystole is the most common presenting rhythm in pediatric cardiac arrest reflects the fact that pediatric arrests are often secondary to respiratory failure or hypoxia rather than primary cardiac events.

From the Research

Presenting Rhythms in Pediatric Arrest

• The percentage of presenting rhythms in pediatric arrest can be broken down as follows:
  • Pulseless electrical activity (PEA): 60% 2
  • Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT): 24% 2, 43.2% 3, 42.5% 4
  • Asystole: 16% 2
• The first documented rhythm is typically asystole or PEA in children 5
• Shockable rhythms are rare in pediatric cardiac arrest, with VF or PVT being the first documented rhythm in 18.2% of cases 3
• A shockable rhythm developed during resuscitation in 56.8% of cases 3 and 57.5% of cases 4

Rhythm Characteristics and Patterns of Change

• During pediatric cardiopulmonary resuscitation (CPR), patients may transition between PEA, asystole, VF/VT, and return of spontaneous circulation (ROSC) 2
• A temporary surge of PEA was observed between 10 and 15 minutes due to a doubling of the transition rate from ROSC to PEA (i.e. 're-arrests') 2
• The prevalence of sustained ROSC reached an asymptotic value of 30% at 20 minutes 2

Clinical Outcome

• Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival, and better final survival than children with subsequent VF or PVT 3, 4
• Survival rate was inversely related to the duration of cardiopulmonary resuscitation 3, 4
• Clinical outcome was not related to the cause or location of arrest, type of defibrillator and waveform, energy dose per shock, number of shocks, or cumulative energy dose 4