Out-of-Hospital Ventricular Fibrillation in Children and Adolescents: Causes and Outcomes, ,

See related editorial, "Is Pediatric Resuscitation Unique? Relative Merits of Early CPR and Ventilation Versus Early Defibrillation for Young Victims of Prehospital Cardiac Arrest" Study objective: To compare causes and outcomes of patients younger than 20 years with an initial rhythm of ventricular fibrillation versus asystole and pulseless electrical activity. Design: Retrospective cohort study. Setting: Urban/suburban prehospital system. Participants: Pulseless, nonbreathing patients less than 20 years who underwent out-of-hospital resuscitation. Patients with lividity or rigor mortis or who were less than 6 months old and died of sudden infant death syndrome were excluded. Results: Ventricular fibrillation was the initial rhythm in 19% (29 of 157) of the cardiac arrests. Rhythm assessment was performed by the first responder in only 44% (69 of 157) of patients. All three rhythm groups were similar in age distribution, frequency of intubation (96%), and vascular access (92%); 93% of ventricular fibrillation patients were defibrillated. The causes of ventricular fibrillation were distributed evenly among medical illnesses, overdoses, drownings, and trauma; only two patients had congenital heart defects. Seventeen percent were discharged with no or mild disability, compared with 2% of asystole/pulseless electrical activity patients (P =.003). Conclusion: Ventricular fibrillation is not rare in child and adolescent prehospital cardiac arrest, and these patients have a better outcome than those with asystole or pulseless electrical activity. Earlier recognition and treatment of ventricular fibrillation might improve pediatric cardiac arrest survival rates. [Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P: Out-of-hospital ventricular fibrillation in children and adolescents: Causes and outcomes. Ann Emerg Med April 1995;25:484-491.]