Abstract 129: Effect of Defibrillation Dose and Waveform Characteristics on Defibrillation Success in Pediatric In-Hospital Cardiac Arrest
Bibliographic record
Abstract
Introduction: Amplitude spectral area (AMSA) predicts successful defibrillation (DF) and return of spontaneous circulation (ROSC) in adults but has not been studied during pediatric in-hospital cardiac arrest (IHCA). Hypothesis: We characterized DF dose and AMSA during pediatric IHCA from a pediatric resuscitation quality (pediRES-Q) collaborative and hypothesized that a threshold value of AMSA could predict successful DF. Methods: Children <18 years with witnessed IHCA, ventricular fibrillation (VF) as the initial rhythm, and those who had complete CPR quality metric data captured from the bedside defibrillator (ZOLL R-Series, Chelmsford, MA) were studied. Energy dose, initial AMSA ( i AMSA) and pre-shock AMSA ( p AMSA) [2.5-sec ECG window before defibrillation] for predicting DF success were calculated, together with receiver operator (ROC) curves. Successful DF (sDF) was defined as return of an organized rhythm 5 seconds after DF. Sustained ROSC was defined as >20 minutes without chest compressions. Events with DF due to ventricular tachycardia, inappropriate shocks (i.e. supraventricular tachycardia, conduction block), unavailable AMSA values, and VF events using <1 J/kg for DF were excluded. Results: Between 2015-2018, 34 subjects (median age 7.4 years [1.3,13.1]; median weight 19.4 kgs [8.9, 41.7]) with IHCA due to VF were enrolled. We analyzed 26 shocks in 18 children < 8 years and 25 shocks in 16 children 8 to <18 years. For children < 8 years, the initial DF median dose/kg was 2.5 [2.3,3.3] J/kg with sDF in 14/26 (54%) shocks and sustained ROSC in 10/18 (56%) children. For those 8 to <18 years, initial DF median dose/kg was 3.0 [2.5,3.4] J/kg with sDF in 10/25 (40%) shocks and sustained ROSC in 10/16 (63%). AMSA was significantly higher prior to sDF than in unsuccessful DF ( p AMSA 19.14±8.11 vs.12.0±7.38 mV-Hz, p = 0.0021; i AMSA 19.08±7.38 vs. 11.04±6.57 mV-Hz, p = 0.0053). Area under the ROC curve was 0.765 for p AMSA and 0.796 for i AMSA. Conclusions: We characterized DF dose and AMSA during pediatric IHCA with an initial rhythm of VF and found that sDF was significantly associated with AMSA >19 mV-Hz. Future studies should determine the AMSA threshold that predicts sDF in children due to differences in heart size and cardiac arrest etiology.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".