Skogvoll E, Nordseth T, Sutton RM, et al. - In order to determine factors affecting the course of resuscitation in patients with in-hospital pediatric cardiac arrests, researchers here examined transitions from pulseless electrical activity (PEA) to ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT), return of spontaneous circulation (ROSC) and recurrences from ROSC to PEA in children and adolescents with in-hospital cardiac arrest. At the Children's Hospital of Philadelphia, they identified registration of 67 episodes of CPR in 59 patients (median age 15 years) with cardiac arrest. Among these cases, 52 transitions from PEA to ROSC, 22 transitions from PEA to VF/pVT, and 23 recurrences of PEA from ROSC were reported. With the exception for a nearly significant influence of mean compression depth beyond a threshold of 5.7 cm, only dynamic factors that developed during CPR favored a transition from PEA to ROSC. The latter comprised a lower proportion of PEA over the last 5 min and a higher proportion of ROSC over the last 5 min. The following factors were linked with PEA to VF/pVT development: age, weight, the proportion spent in VF/pVT or PEA the last 5 min, and the general transition intensity, while PEA recurrence from ROSC only depended on the general transition intensity. Findings thereby suggest the main influence of the dynamic factors associated with time in PEA and ROSC on the clinical course during pediatric cardiac arrest. Deeper compressions seemed favoring transitions from PEA to ROSC.

were prospectively registered. Defibrillators that recorded chest compression depth/rate and ventilation rate were applied.