The immediate use of an Automated External Defibrillator (AED) is a time-sensitive intervention that can significantly increase the chance of survival for an infant experiencing sudden cardiac arrest. Applying the defibrillation pads correctly is a straightforward action that allows the device to analyze the heart’s rhythm and deliver a corrective electrical shock if necessary. The effectiveness of this equipment depends on the proper preparation of the patient and the precise placement of the pads to ensure the electrical current passes directly through the heart muscle.
Defining the Equipment and Patient
For the purpose of using an AED, an “infant” is defined as a child under one year of age, though protocols for pediatric pads often apply to children up to eight years old or those weighing less than 55 pounds (25 kg). The primary difference between treating an adult and a smaller patient lies in the amount of electrical energy delivered. Standard adult AED pads deliver a high-energy shock, typically between 120 and 200 joules, which is too powerful for an infant.
It is recommended to use attenuated pediatric pads, if available, as these pads reduce the energy dose to a much lower, safer level, often around 50 joules. Pediatric pads are also smaller in size, which prevents them from touching each other when placed on a small chest. If pediatric pads are not immediately available, adult pads should still be used, but special attention must be paid to their placement to prevent contact.
Step-by-Step Pad Placement
The physical size of an infant necessitates a distinct placement method for the AED pads, known as the anterior-posterior position. This configuration ensures the heart is effectively positioned between the pads to maximize the delivery of the electrical current. The goal is to prevent the pads from touching, which would cause the electrical charge to short-circuit across the skin rather than passing through the chest cavity.
The first pad, or the anterior pad, should be placed on the center of the infant’s chest, just below the collarbone or sternum. This location positions one side of the electrical circuit directly over the front of the heart. The pad should be pressed firmly onto the bare skin to ensure complete adhesion and good electrical contact.
Next, the infant must be carefully rolled onto their side to expose their back. The posterior pad is then affixed to the center of the infant’s back, positioned directly between the shoulder blades. This placement completes the circuit, with the heart lying squarely in the path of the electrical current. This front-and-back setup allows for an effective shock delivery.
Key Pre-Application Safety Checks
Before the pads are applied to the infant’s skin, several safety checks must be performed to ensure the AED functions correctly and safely. The infant’s chest and back must be completely bare, meaning all clothing must be quickly removed or cut away. Any metallic jewelry that might be in the path of the electrical current should also be removed.
It is important that the skin where the pads will be placed is dry. If the infant’s skin is wet from sweat, water, or other fluids, the electrical current may travel across the surface of the skin instead of penetrating through the heart, rendering the shock ineffective. A towel or cloth should be used to quickly wipe the skin dry.
If any medication patches are present on the infant’s chest or back, they must be removed, and the area should be wiped clean. Some patches contain metallic components or chemicals that can interfere with the electrical impulse. If an implanted device like a pacemaker is visible, the AED pads must be placed away from the site of the device to prevent interference or damage.
Activating the AED and Post-Application Steps
Once the pads are securely placed in the anterior-posterior position, the connector cable must be plugged into the AED machine itself. The rescuer should then follow the verbal and visual prompts provided by the device, which will guide the remainder of the sequence. The AED will immediately begin to analyze the infant’s heart rhythm, a process during which the rescuer must ensure no one is touching the infant.
If the AED determines a shockable rhythm is present, it will advise a shock and begin to charge. At this point, the rescuer must loudly announce “Stand Clear” and physically confirm that everyone is away from the infant before pressing the shock button when prompted. The shock is delivered in a fraction of a second.
Immediately after the shock is delivered, or if the AED advises “No shock advised,” the rescuer must promptly resume high-quality cardiopulmonary resuscitation (CPR). The AED pads should remain attached to the infant, as the machine will re-analyze the heart rhythm after approximately two minutes of CPR and issue new prompts if necessary. CPR should continue without interruption until emergency medical services arrive and take over care.