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Transthoracic direct current shock is the recommended treatment for ventricular fibrillation in children as in adults. To determine the appropriate energy dose, data were collected from 71 defibrillation attempts in 27 children. Sixty-three of the 71 shocks (89%) were successful in terminating fibrillation. Fifty-seven shocks were within 10 watt-seconds (w-sec) above or below an energy dose of 2 w-sec/kg of body weight. Fifty-two (91%) of these were effective and five (9%) were ineffective. In every case, fibrillation was ultimately terminated by a shock of 4 w-sec/kg or less. The results of these studies suggest that an energy dose of 2 w-sec/kg (or approximately 1 w-sec/lb) is adequate to defibrillate most children weighing under 50 kg. We currently use 2 w-sec/kg and double the energy dose if the first defibrillation attempt is unsuccessful.
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