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• Automatic external defibrillation in a 6 year old
  Robert M Bingham
  Published on: 10 March 2005

• Published on: 10 March 2005

  Automatic external defibrillation in a 6 year old

  • Robert M Bingham, Consultant Paediatric Anaesthetist
  • Other Contributors:
    • Bob Berg, Mary-Fran Hazinski, Ric Sansom and Steve Schexnayder

  Dear Editor,

  We were interested in the article by Konig, Benger and Goldsworthy [1] describing the use of an Automated External Defibrillator (AED) in a 6- year-old child and would like to congratulate them and the paramedic team on saving this girl’s life.

  As the authors point out in their discussion, data on the use of AEDs in children is scant and any publication in this area is encouraged. In the ab...

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  Dear Editor,

  We were interested in the article by Konig, Benger and Goldsworthy [1] describing the use of an Automated External Defibrillator (AED) in a 6- year-old child and would like to congratulate them and the paramedic team on saving this girl’s life.

  As the authors point out in their discussion, data on the use of AEDs in children is scant and any publication in this area is encouraged. In the absence of good quality information, the International Liaison Committee on Resuscitation (ILCOR) did not feel able to recommend their use in children less than 8 years old in its International Guidelines 2000 for CPR and ECC. A major concern was that an AED may not have adequate specificity for analysis of paediatric arrhythmias and consequently recommend a potentially damaging shock inappropriately. Clearly, if a child is certainly in ventricular fibrillation (VF), the risk of an adult energy level shock is less than no shock at all.

  Since the 2000 consensus process, further evidence on the specificity of rhythm analysis in children [2] and the safety of shocks of greater than 4J/kg [3] have, together with the increasing distribution of AEDs in both hospital and community, prompted an update and revision of the original statement. This was published in Circulation [4] Resuscitation [5] and Pediatrics [6] in 2003. Information on this subject is also on the Resuscitation Council (UK) website [7].

  The current recommendation is: “Standard Automated External Defibrillators (AEDs) may be used in children over 1 year of age who have no signs of circulation. Ideally, the device should deliver a paediatric dose. The arrhythmia detection algorithm used in the device should demonstrate high specificity for paediatric shockable rhythms, i.e. it will not recommend delivery of a shock for nonshockable rhythms”.

  Two points in this statement deserve clarification:

  Delivery of a paediatric dose from an AED may be achieved by the use of a manually adjustable model or by the use of paediatric pads, which attenuate the output to (typically) 50-80J.

  Not all manufacturers have tested their machines against paediatric arrhythmias and this should be considered when evaluating machines for purchase if there is any possibility they might need to be used in paediatric patients.

  The incidence of VF in children requiring resuscitation is traditionally thought to be 7-10% although the true incidence may be higher, particularly if early rhythm analysis is performed [8]. It is extremely important to identify this group as the outcome from this form of cardiac arrest is likely to be good with prompt defibrillation. The appropriate use of AEDs in children should be encouraged.

  References

  1. Konig B, Benger J and Goldsworthy L. Automatic external defibrillation in a 6 year old. Arch Dis Child. 2005;90:310-311

  2. Cecchin F, Jorgenson DB, Berul CI, Perry JC, Zimmerman AA, Duncan BW, Lupinetti FM, Snyder D, Lyster TD, Rosenthal GL, Cross B, Atkins DL.Is arrhythmia detection by automatic external defibrillator accurate for children?: sensitivity and specificity of an automatic external defibrillator algorithm in 696 pediatric arrhythmias. Circulation. 2001;103:2483-2488.

  3. Gurnett CA, Atkins DL. Successful use of a biphasic waveform automated external defibrillator in a high-risk child. Am J Cardiol. 2000;86:1051-1053.

  4. Samson RA. Berg RA. Bingham R et al. Use of automated external defibrillators for children: an update: an advisory statement from the Pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation. Circulation. 2003;107(25):3250-5.

  5. Ditto. Resuscitation. 2003;57(3):237-43.

  6. Ditto. Pediatrics. 2003;112(1):163-168.

  7. http://www.resus.org.uk

  8. Mogayzel C, Quan L, Graves JR. Our-of-hospital ventricular fibrillation in children and adolescents: Causes and outcomes. Ann Emerg Med. 1995;25:484-491.

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  Conflict of Interest:
  None declared.

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