Paediatric anaesthesia & critical care
Pulseless electrical activity versus asystole as initial pulseless rhythm in children: challenging convention regarding non-shockable rhythms
Authors' conclusion
PEA and asystole differ in patient characteristics and short-term resuscitation outcomes in pediatric IHCA. However, the overall survival difference appears driven by neonates and NICU-associated events, with no significant survival difference in older children.
Study context
- Population
- Children (<18 years) with in-hospital cardiac arrest (IHCA) and initial rhythm pulseless electrical activity (PEA) or asystole, AHA GWTG-R registry, 2000–2023
- Participants
- 9,423 children
- Exposure
- Asystole vs PEA as initial pulseless rhythm
- Asystolen = 4,007
- PEAn = 5,416reference
- Outcome
- ROSC; ROC (ROSC or ROC with ECMO); survival to hospital discharge
Methodological detailsmulticentre registry, mixed-effects regression
- Multicentre registry
- Mixed-effects regression
Main finding
As reported in the abstract
ROSC, ROC and survival to discharge
Asystole vs PEAAdjusted odds ratio (95% CI)
ROSC
0.70(0.64–0.77)
ROC
0.71(0.64–0.78)
Survival to discharge
0.89(0.81–0.99)
Observational data: associations, not effects.
Further findings
| Outcome | PEA | Asystole | aOR (95% CI) | |
|---|---|---|---|---|
| Survival to discharge, NICU-excluded cohort | 36.1% | 34.1% | 0.99 (0.90–1.11) | |
| 0.512Adjusted odds ratio (log scale) |
Survival to discharge, NICU-excluded cohort
- Asystole still associated with lower odds of return of spontaneous circulation (ROSC) and ROC in NICU-excluded cohort
Survival to discharge, age-stratified (subgroup)
- Overall survival difference driven by neonates; no difference between PEA and asystole in older age groups
Original publication
Pulseless electrical activity versus asystole as initial pulseless rhythm in children: challenging convention regarding non-shockable rhythms. Resuscitation. Published 3 September 2026. doi:10.
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