Acute cardiac care & resuscitationCohort study
Pulseless electrical activity versus asystole as initial pulseless rhythm in children: challenging convention regarding non-shockable rhythms
- registry analysis
- mixed-effects regression
- American Heart Association Get With The Guidelines-Resuscitation (GWTG®-R) registry (2000-2023)
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
- Pediatric (<18 years) in-hospital cardiac arrest cases with an initial rhythm of pulseless electrical activity (PEA) or asystolePEA 5,416 · asystole 4,007
- Participants
- 9,423 patients
- Exposure
- asystole compared with PEA
- asystolen = 4,007 (42.5%)
- PEAn = 5,416 (57.5%)reference
Main finding
ROSC
Adjusted odds ratio
0.70
95% CI 0.64–0.77
asystole vs PEA
aOR 0.70 (95% CI 0.64–0.77)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | PEA | asystole | aOR (95% CI) | |
|---|---|---|---|---|
| ROC · lower odds with asystole | 0.71 (0.64–0.78) | |||
| survival to discharge · lower odds with asystole | 0.89 (0.81–0.99) | |||
| survival to discharge, NICU-excluded cohort · no longer differed | 36.1% | 34.1% | 0.99 (0.90–1.11) | |
| 0.512Adjusted odds ratio (log scale) |
Return of spontaneous circulation (ROSC) and ROC, NICU-excluded cohort
- asystole remained associated with lower odds of ROSC and ROC
survival to discharge, age-stratified
- overall survival difference was driven by neonates; in older age groups, survival to discharge did not differ between PEA and asystole
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:10.1016/j.resuscitation.2026.111289
Summarised from the published abstract; every number is checked against it