Use of Automated External Defibrillators for Children

CAEP Position Statements

CJEM 2005;7(2):128

Heart and Stroke Foundation of Canada

Use of Automated External Defibrillators for Children¹
ILCOR Advisory Statement, October 2002

Background

• Outside of a hospital setting, the use of an automated external defibrillator (AED) within the first 3 minutes of a witnessed adult ventricular fibrillation (VF) arrest results in survivor rates of greater than 50%.
• For every one minute delay in defibrillation, the survival rate of a cardiac arrest victim decreases by 7 to 10%.
• After more than 12 minutes of VF, the survival rate of adults is less than 5%.
• In some settings (e.g. casinos, airport terminals) AED use has substantially improved the rate of survival from VF in adults.
• Trained responders have effectively used AEDs in many public settings, including casinos, airport terminals, and airplanes.
• VF is an uncommon cause of out-of-hospital pediatric cardiac arrest in infants (less than 1 year of age), but its occurrence increases with age.
• In-hospital studies of pediatric cardiopulmonary resuscitation (CPR) indicate that VF is not a rare rhythm among children in cardiac arrest.
• Previous recommendations limited AED use to children 8 years of age or older because of the concern that the minimum fixed energy level that AEDs deliver would be too high for smaller children and would damage the myocardium. A second concern was that the higher heart rate of children might be interpreted as VF by an AED and therefore shock inappropriately.
• Published reports and studies suggest that AEDs provide sensitive and specific rhythm analysis in infants and children.
• Because of increased thoracic impedance in young children, energy delivered to the heart may be lower than predicted.
• Limited data suggests that higher energy may be effective in children and does not cause myocardial damage.
• Pediatric cables which increase impedance and divert some energy away from the patient have been developed for the AED.

Recommendations

The Heart and Stroke Foundation of Canada recommends that:

1. Automated external defibrillators (AEDs) may be used for children 1 to 8 years of age with no signs of circulation. Ideally the device should deliver a pediatric-adjusted energy level but this is not a necessary requirement. The arrhythmia detection algorithm used in the device should demonstrate high specificity for pediatric shockable rhythms, i.e., it will not recommend delivery of a shock for nonshockable rhythms.
2. Every effort is made to confirm that the AED is safe when attached to and used on a child who does not have a shockable rhythm and who could be harmed by an inappropriate shock.
3. A lone rescuer responding to a child (1 to 8 years of age, less than 25 kg) without signs of circulation activate the emergency medical services (EMS) system before any other action and provide 1 minute of CPR before attaching the AED.
4. Institutions that routinely care for children at risk for arrhythmias and cardiac arrest (e.g. in-hospital settings) continue to use defibrillators capable of energy adjustment for weight-based doses.
5. There is insufficient evidence for the Heart and Stroke Foundation of Canada to support a recommendation for or against the use of AEDs in children less than 1 year of age.
6. Hospitals and EMS systems that employ AEDs should develop specific guidelines for use of AEDs in children.

Reference

1. Pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation. 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;3250-5.

The evidence contained in this Position Statement is current as of:
December 2004