The Automated External Defibrillator is a device that delivers an electrical shock to a heart experiencing an abnormal, life-threatening rhythm. In the event of sudden cardiac arrest in an infant, the time between collapse and effective intervention significantly impacts survival. Since an infant’s cardiac arrest often stems from respiratory failure, early intervention with cardiopulmonary resuscitation and defibrillation provides the best chance for a positive outcome. Correct placement of the electrode pads is mandatory for the device to function effectively and safely. This process differs substantially from placement on adults due to the infant’s smaller body size and unique anatomy.
Selecting and Preparing the Correct Equipment
The first step is ensuring you have the appropriate equipment for the patient’s size. Infants (under one year old or weighing less than 55 pounds) require pediatric-specific electrode pads. These pads fit the smaller chest without touching and deliver an attenuated, or reduced, dose of electrical energy. This lower energy is necessary because an infant’s smaller body requires less electrical current for successful defibrillation.
If pediatric pads are unavailable, adult pads must be used, as providing a shock is better than providing no shock at all. When using adult pads, it is important to ensure they do not touch each other on the chest or back. Placement must be modified to prevent this contact, which could cause a short circuit and ineffective energy delivery.
Preparation of the infant’s skin is crucial for successful defibrillation. The chest must be bare so the pads adhere directly to the skin, allowing the electrical current to travel effectively. If the chest is wet or damp, wipe it dry before applying the pads. Excessive chest hair should be removed if it prevents the pads from making firm contact.
Detailed Anterior-Posterior Pad Placement for Infants
The physical difference between an adult and an infant necessitates anterior-posterior placement. This technique ensures the heart is positioned directly between the two pads, maximizing the current’s path through the cardiac tissue. Standard adult placement (both pads on the front) is unsafe because the pads would risk touching or overlapping on the smaller chest.
The first pad (anterior) should be placed high on the right side of the infant’s chest, just below the collarbone. This position avoids the space between the nipples, which is reserved for chest compressions. The second pad (posterior) is placed on the infant’s back, directly between the shoulder blades.
When correctly positioned, the electrical current passes from the front pad, through the heart, and exits through the back pad. This is the most effective way to deliver the therapeutic shock. Once placed, the pads must be firmly pressed onto the skin to remove air pockets and ensure complete adhesion. A secure connection is necessary for the AED to analyze the heart rhythm accurately and deliver the shock safely.
Integrating Pad Placement into the Resuscitation Sequence
Pad placement occurs alongside cardiopulmonary resuscitation (CPR). After recognizing the need for intervention and activating the emergency response system, high-quality chest compressions are the immediate priority. The pads should be applied to the infant’s body while CPR is being performed, minimizing any interruption to compressions.
Once the pads are adhered and the connecting cable is plugged into the AED unit, the device should be turned on. The rescuer must follow the specific voice prompts given by the machine. The AED will immediately begin to analyze the infant’s heart rhythm, and during this analysis, no one should touch the patient to prevent interference.
If the AED determines a shockable rhythm is present, it will prompt the rescuer to deliver a controlled shock. Before pressing the shock button, the rescuer must verbally confirm that everyone is clear of the infant. Following the shock, or if the AED advises no shock is necessary, the rescuer must immediately resume chest compressions without delay. The continuous cycle of two minutes of CPR followed by AED analysis should continue until advanced medical help arrives or the infant shows signs of life.