An Automated External Defibrillator (AED) is a portable electronic device designed to automatically diagnose life-threatening cardiac arrhythmias and treat them through defibrillation. While sudden cardiac arrest is less common in children than in adults, it still affects thousands of young people annually. Cardiac arrest in children is often a secondary event, frequently resulting from respiratory failure, but it can also be caused by underlying heart issues. Yes, an AED should be used, but with specific considerations for safety and equipment.
The Necessity and Safety of Pediatric Defibrillation
Although a child’s cardiac arrest may stem from a lack of oxygen rather than a primary electrical problem, a shockable rhythm, such as ventricular fibrillation, can still occur and requires immediate defibrillation. For every minute defibrillation is delayed, the chance of survival decreases significantly. This makes the prompt use of the nearest AED a priority regardless of the patient’s age.
The primary safety concern when using a defibrillator on a child is the delivery of too much electrical energy to their smaller body and heart. The recommended guidelines for pediatric patients generally apply to children under eight years old or those weighing less than 55 pounds (25 kilograms). Using an adult dose on a small child risks causing damage to the heart muscle. This potential for excessive energy necessitates the use of specialized equipment to safely reduce the electrical dosage.
Specialized Equipment and Energy Dosage
Specialized equipment is required for effective and safe pediatric defibrillation. Pediatric electrode pads are physically smaller than adult pads, which is necessary to ensure proper contact with the child’s chest without touching each other. When pads touch, the electrical current can arc between them, bypassing the heart and potentially burning the skin.
Beyond size, pediatric pads often contain a dose attenuation system, which acts as a resistor to reduce the energy delivered from the AED unit. This mechanism typically lowers the electrical dose to approximately 50 joules, which is about one-third or one-fourth of the standard adult dose of 120 to 200 joules. Some AED units feature a dedicated child key or a switch that activates the internal attenuation setting, allowing the use of the same pads but reducing the energy output.
If only standard adult pads are immediately available, they should be used, as administering a shock is better than delaying defibrillation. If using adult pads on a small child, it is crucial to ensure they do not touch each other, which may require placing them in a different configuration. The adult pads will deliver the full, unattenuated energy dose, which carries a higher risk but still provides the only chance of survival for a shockable rhythm.
Applying the AED: Step-by-Step Instructions
If an AED is available, call for emergency medical services and immediately begin cardiopulmonary resuscitation (CPR). One rescuer should continue high-quality chest compressions while the other prepares the device. The AED should be turned on, and the voice prompts followed exactly as they are given.
The electrode pads must be applied to the child’s bare, dry chest. For children, the preferred placement is often an anterior-posterior configuration. One pad is placed on the front of the chest, over the breastbone, and the other pad is placed on the child’s back between the shoulder blades. This front-and-back positioning ensures the heart is effectively situated between the two pads.
The device will analyze the heart rhythm and only advise a shock if it detects a ventricular fibrillation or pulseless ventricular tachycardia. If the AED advises a shock, the rescuer must ensure no one is touching the child before pressing the shock button. Immediately after the shock is delivered, or if “No Shock Advised” is prompted, the rescuer must immediately resume CPR, continuing compressions and breaths until the child shows signs of life or professional help arrives.