Ventricular Fibrillation and the Use of Automated External Defibrillators on Children

Abstract

The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.

Automated external defibrillator use in a previously healthy 31‐day‐old infant with out‐of‐hospital cardiac arrest due to ventricular fibrillation

“…Current guidelines recognize a knowledge gap in the lowest age and weight for safe and effective AED use, though they ultimately recommend their use in infants with apparent cardiac arrest . Hesitancy for AED use in small infants arises from a concern for myocardial damage from energy doses of adult or even pediatric‐attenuated AED pads.…”

“…Automated external defibrillators (AEDs) have been successfully used in children, but relatively little is known regarding their safety in neonates and infants . Current guidelines recognize a knowledge gap in the lowest age and weight for safe and effective use . The purpose of this case presentation is to exemplify AED use in early infancy and illustrate a rare syndrome of infant ventricular fibrillation (VF).…”

“…[1][2][3][4] Current guidelines recognize a knowledge gap in the lowest age and weight for safe and effective use. [5][6][7] The purpose of this case presentation is to exemplify AED use in early infancy and illustrate a rare syndrome of infant ventricular fibrillation (VF).…”

Out-of-hospital ventricular fibrillation in three adolescents

“…A retrospective study of cardiac arrest reported ventricular fibrillation rates of 7.6% for children 1–7 years of age and 27.0% for children 8–18 years of age, with an overall incidence of ventricular fibrillation of 17.6% 2. Many guidelines, including those of the International Liaison Committee on Resuscitation, the American Heart Association (AHA), and the National Association of EMS Physicians, now advocate AED use on children to analyse rhythms and provide early defibrillation in cases of ventricular fibrillation 3 – 5…”

Medical Emergencies Occurring at School

“…14,15 An AED program is to be covered by a school policy, 16 and staff members who are trained for such use are to be able to respond effectively to first aid and cardiopulmonary emergencies. Sudden cardiac arrest has an estimated annual incidence of 0.7 to 1.0 per 1000 population [17][18][19][20] and is responsible for Ͼ50% of all deaths attributable to cardiovascular disease in the United States.…”