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Critical Care
Published in: Critical Care 6/2012

Open Access 01-12-2012 | Research

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

Authors: Seizan Tanabe, Hideo Yasunaga, Soichi Koike, Manabu Akahane, Toshio Ogawa, Hiromasa Horiguchi, Tetsuo Hatanaka, Hiroyuki Yokota, Tomoaki Imamura

Published in: Critical Care | Issue 6/2012

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Abstract

Introduction

Conventional 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.

Methods

This 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.

Results

Among 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).

Conclusions

The present nationwide population-based observational study could not confirm an advantage of biphasic over monophasic defibrillators for pediatric OHCA patients.
Literature
1.
Hickey RW, Cohen DM, Strausbaugh S, Dietrich AM: Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med 1995, 25: 495-501. 10.1016/S0196-0644(95)70265-2CrossRefPubMed
2.
Appleton GO, Cummins RO, Larson MP, Graves JR: CPR and the single rescuer: at what age should you "call first" rather than "call fast"? Ann Emerg Med 1995, 25: 492-494. 10.1016/S0196-0644(95)70264-4CrossRefPubMed
3.
Ronco R, King W, Donley DK, Tilden SJ: Outcome and cost at a children's hospital following resuscitation for out-of-hospital cardiopulmonary arrest. Arch Pediatr Adolesc Med 1995, 149: 210-214. 10.1001/archpedi.1995.02170140092017CrossRefPubMed
4.
Losek JD, Hennes H, Glaeser P, Hendley G, Nelson DB: Prehospital care of the pulseless, nonbreathing pediatric patient. Am J Emerg Med 1987, 5: 370-374. 10.1016/0735-6757(87)90383-4CrossRefPubMed
5.
Safranek DJ, Eisenberg MS, Larsen MP: The epidemiology of cardiac arrest in young adults. Ann Emerg Med 1992, 21: 1102-1106. 10.1016/S0196-0644(05)80651-1CrossRefPubMed
6.
Osswald S, Trouton TG, O'Nunain SS, Holden HB, Ruskin JN, Garan H: Relation between shock-related myocardial injury and defibrillation efficacy of monophasic and biphasic shocks in a canine model. Circulation 1994, 90: 2501-2509. 10.1161/01.CIR.90.5.2501CrossRefPubMed
7.
Gliner BE, Lyster TE, Dillion SM, Bardy GH: Transthoracic defibrillation of swine with monophasic and biphasic waveforms. Circulation 1995, 92: 1634-1643. 10.1161/01.CIR.92.6.1634CrossRefPubMed
8.
Bardy GH, Gliner BE, Kudenchuk PJ, Poole JE, Dolack GL, Jones GK, Anderson J, Troutman C, Johnson G: Truncated biphasic pulses for transthoracic defibrillation. Circulation 1995, 91: 1768-1774. 10.1161/01.CIR.91.6.1768CrossRefPubMed
9.
Bardy GH, Marchlinski FE, Sharma AD, Worley SJ, Luceri RM, Yee R, Halperin BD, Fellows CL, Ahern TS, Chilson DA, Packer DL, Wilber DJ, Mattioni TA, Reddy R, Kronmal RA, Lazzara R: Multicenter comparison of truncated biphasic shocks and standard damped sine wave monophasic shocks for transthoracic ventricular defibrillation: Transthoracic Investigators. Circulation 1996, 94: 2507-2514. 10.1161/01.CIR.94.10.2507CrossRefPubMed
10.
White RD: Early out-of-hospital experience with an impedance-compensating low-energy biphasic waveform automatic external defibrillator. J Interv Card Electrophysiol 1997, 1: 203-208. discussion 209-210 10.1023/A:1009712721915CrossRefPubMed
11.
Poole JE, White RD, Kanz KG, Hengstenberg F, Jarrard GT, Robinson JC, Santana V, McKenas DK, Rich N, Rosas S, Merritt S, Magnotto L, Gallagher JV, Gliner BE, Jorgenson DB, Morgan CB, Dillon SM, Kronmal RA, Bardy GH: Low-energy impedance-compensating biphasic waveforms terminate ventricular fibrillation at high rates in victims of out-of-hospital cardiac arrest: LIFE Investigators. J Cardiovasc Electrophysiol 1997, 8: 1373-1385. 10.1111/j.1540-8167.1997.tb01034.xCrossRefPubMed
12.
Gliner BE, Jorgenson DB, Poole JE, White RD, Kanz KG, Lyster TD, Leyde KW, Powers DJ, Morgan CB, Kronmal RA, Bardy GH: Treatment of out-of-hospital cardiac arrest with a low-energy impedance-compensating biphasic waveform automatic external defibrillator: The LIFE Investigators. Biomed Instrum Technol 1998, 32: 631-644.PubMed
13.
Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE: Part 6: Electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010, 122: S706-S719. 10.1161/CIRCULATIONAHA.110.970954CrossRefPubMed
14.
Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A: Nationwide public-access defibrillation in Japan. N Engl J Med 2010, 362: 994-1004. 10.1056/NEJMoa0906644CrossRefPubMed
15.
Tanigawa K, Tanaka K: Emergency medical service systems in Japan: past, present, and future. Resuscitation 2006, 69: 365-370. 10.1016/j.resuscitation.2006.04.001CrossRefPubMed
16.
Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: advanced cardiovascular life support: section 8: postresuscitation care: The American Heart Association in collaboration with the International Liaison Committee on Resuscitation Circulation 2000, 102: I166-I171.
17.
2005 American Heart Association: Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005, 112: IV1-203.CrossRef
18.
Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T: Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study. BMJ 2010, 342: c7106. 10.1136/bmj.c7106CrossRef
19.
Yasunaga H, Horiguchi H, Tanabe S, Akahane M, Ogawa T, Koike S, Imamura T: Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study. Crit Care 2010, 14: R199. 10.1186/cc9319PubMedCentralCrossRefPubMed
20.
Akahane M, Ogawa T, Tanabe S, Koike S, Horiguchi H, Yasunaga H, Imamura T: Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. Crit Care Med 2012, 40: 1410-1416. 10.1097/CCM.0b013e31823e99aeCrossRefPubMed
21.
Koike S, Ogawa T, Tanabe S, Matsumoto S, Akahane M, Yasunaga H, Horiguchi H, Imamura T: Collapse-to-emergency medical service cardiopulmonary resuscitation interval and outcomes of out-of-hospital cardiopulmonary arrest: a nationwide observational study. Crit Care 2011, 15: R120. 10.1186/cc10219PubMedCentralCrossRefPubMed
22.
Tanabe S, Ogawa T, Akahane M, Koike S, Horiguchi H, Yasunaga H, Mizoguchi T, Hatanaka T, Yokota H, Imamura T: Comparison of neurological outcome between tracheal intubation and supraglottic airway device insertion of out-of-hospital cardiac arrest patients: a nationwide, population-based, observational study. J Emerg Med 2012, in press.
23.
Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S: Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA 2012, 307: 1161-1168. 10.1001/jama.2012.294CrossRefPubMed
24.
Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991, 84: 960-975. 10.1161/01.CIR.84.2.960CrossRefPubMed
25.
Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F: Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 2004, 110: 3385-3397. 10.1161/01.CIR.0000147236.85306.15CrossRefPubMed
26.
Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, Bruckner T, Satariano WA: To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology 2010, 21: 467-474. 10.1097/EDE.0b013e3181caeb90CrossRefPubMed
27.
Berg RA, Chapman FW, Berg MD, Hilwig RW, Banville I, Walker RG, Nova RC, Sherrill D, Kern KB: Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation. Resuscitation 2004, 61: 189-197. 10.1016/j.resuscitation.2003.12.021CrossRefPubMed
28.
Tang W, Weil MH, Jorgenson D, Klouche K, Morgan C, Yu T, Sun S, Snyder D: Fixed-energy biphasic waveform defibrillation in a pediatric model of cardiac arrest and resuscitation. Crit Care Med 2002, 30: 2736-2741. 10.1097/00003246-200212000-00019CrossRefPubMed
29.
Clark CB, Zhang Y, Davies LR, Karlsson G, Kerber RE: Pediatric transthoracic defibrillation: biphasic versus monophasic waveforms in an experimental model. Resuscitation 2001, 51: 159-163. 10.1016/S0300-9572(01)00398-7CrossRefPubMed
30.
Tanabe S, Yasunaga H, Ogawa T, Koike S, Akahane M, Horiguchi H, Hatanaka T, Yokota H, Imamura T: Comparison of outcomes after use of biphasic or monophasic defibrillators among out-of-hospital cardiac arrest patients: a nationwide population-based observational study. Circ Cardiovasc Qual Outcomes 2012, 1: 689-696.CrossRef
31.
Schneider T, Martens PR, Paschen H, Kuisma M, Wolcke B, Gliner BE, Russell JK, Weaver WD, Bossaert L, Chamberlain D: Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims: Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation 2000, 102: 1780-1787. 10.1161/01.CIR.102.15.1780CrossRefPubMed
32.
Morrison LJ, Dorian P, Long J, Vermeulen M, Schwartz B, Sawadsky B, Frank J, Cameron B, Burgess R, Shield J, Bagley P, Mausz V, Brewer JE, Lerman BB: Out-of-hospital cardiac arrest rectilinear biphasic to monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT). Resuscitation 2005, 66: 149-157. 10.1016/j.resuscitation.2004.11.031CrossRefPubMed
33.
van Alem AP, Chapman FW, Lank P, Hart AA, Koster RW: A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest. Resuscitation 2003, 58: 17-24. 10.1016/S0300-9572(03)00106-0CrossRefPubMed
34.
Kudenchuk PJ, Cobb LA, Copass MK, Olsufka M, Maynard C, Nichol G: Transthoracic incremental monophasic versus biphasic defibrillation by emergency responders (TIMBER): a randomized comparison of monophasic with biphasic waveform ascending energy defibrillation for the resuscitation of out-of-hospital cardiac arrest due to ventricular fibrillation. Circulation 2006, 114: 2010-2018. 10.1161/CIRCULATIONAHA.106.636506CrossRefPubMed
35.
Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB (Eds): Estimating sample size and power In Designing Clinical Research. 3rd edition. Philadelphia: Lippincott Williams & Wilkins; 2006. Chapter 6
36.
Fiser DH: Assessing the outcome of pediatric intensive care. J Pediatr 1992, 121: 68-74. 10.1016/S0022-3476(05)82544-2CrossRefPubMed
Metadata
Title
Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in Japan
Authors
Seizan Tanabe
Hideo Yasunaga
Soichi Koike
Manabu Akahane
Toshio Ogawa
Hiromasa Horiguchi
Tetsuo Hatanaka
Hiroyuki Yokota
Tomoaki Imamura
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11864

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