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Pediatr Emerg Care. 2015 Jul;31(7):526-30. doi: 10.1097/PEC.0000000000000490.

The Use of Automated External Defibrillators in Infants: A Report From the American Red Cross Scientific Advisory Council.

Author information

1
From the *The Cardiac Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; †Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical School, Arlington, TX; ‡Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA; §Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; ∥Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX; ¶Global First Aid Red Cross Centre, Paris, France; #Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX; **Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; ††Sky Ridge Medial Center, Lone Tree, CO; and ‡‡Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX.

Abstract

OBJECTIVE:

Automated external defibrillators (AEDs) have been used successfully in many populations to improve survival for out-of-hospital cardiac arrest. While ventricular fibrillation and pulseless ventricular tachycardia are more prevalent in adults, these arrhythmias do occur in infants. The Scientific Advisory Council of the American Red Cross reviewed the literature on the use of AEDs in infants in order to make recommendations on use in the population.

METHODS:

The Cochrane library and PubMed were searched for studies that included AEDs in infants, any external defibrillation in infants, and simulation studies of algorithms used by AEDs on pediatric arrhythmias.

RESULTS:

There were 4 studies on the accuracy of AEDs in recognizing pediatric arrhythmias. Case reports (n = 2) demonstrated successful use of AED in infants, and a retrospective review (n = 1) of pediatric pads for AEDs included infants. Six studies addressed defibrillation dosages used. The algorithms used by AEDs had high sensitivity and specificity for pediatric arrhythmias and very rarely recommended a shock inappropriately. The energy doses delivered by AEDs were high, although in the range that have been used in out-of-hospital arrest. In addition, there are data to suggest that 2 to 4 J/kg may not be effective defibrillation doses for many children.

CONCLUSIONS:

In the absence of prompt defibrillation for ventricular fibrillation or pulseless ventricular tachycardia, survival is unlikely. Automated external defibrillators should be used in infants with suspected cardiac arrest, if a manual defibrillator with a trained rescuer is not immediately available. Automated external defibrillators that attenuate the energy dose (eg, via application of pediatric pads) are recommended for infants. If an AED with pediatric pads is not available, the AED with adult pads should be used.

PMID:
26148104
DOI:
10.1097/PEC.0000000000000490
[Indexed for MEDLINE]

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