Sudden cardiac arrest (SCA) in children requires immediate and definitive intervention to maximize the chance of survival. SCA occurs when the heart’s electrical system malfunctions, often leading to ventricular fibrillation, a chaotic rhythm that prevents effective blood pumping. Automated External Defibrillators (AEDs) deliver an electrical shock to reset the heart’s rhythm. Rapid deployment of an AED is paramount, but a challenge arises when specialized pediatric equipment is not immediately present.
Why Pediatric Pads Are Necessary
Specialized pediatric pads or attenuation keys are the standard of care for children weighing less than 55 pounds (25 kilograms) or typically younger than eight years old. A child’s smaller body mass and heart size are susceptible to damage from the high-energy electrical currents designed for adults. The standard adult shock delivers a significantly higher dose of energy, measured in joules, which can harm the developing myocardium.
Pediatric pads incorporate a resistor that effectively reduces the energy output from the AED. This process, known as energy attenuation, lowers the delivered joules to a safe and effective level for a smaller body. For example, a device delivering 150 to 200 joules to an adult is typically reduced to 50 to 75 joules for a child. Using the correct pediatric equipment is the safest way to deliver the lowest effective energy dose to terminate the life-threatening rhythm.
Using Adult Pads When Pediatric Equipment is Unavailable
While specialized pediatric equipment is preferred, delaying defibrillation to search for the correct pads significantly lowers survival chances. If a child is experiencing a shockable rhythm, the lack of pediatric pads should not delay the immediate application of adult pads. The risk of delivering a higher energy shock is outweighed by the risk of death from prolonged ventricular fibrillation.
The window of opportunity to successfully defibrillate is brief, decreasing the chance of survival by approximately 10% every minute the shock is delayed. Therefore, the decision to use available adult pads must be made quickly. The primary goal is the immediate termination of the lethal arrhythmia.
Major life support organizations advocate for using adult pads as a last resort when pediatric equipment is missing. This emergency deviation recognizes that delivering too much energy is preferable to delivering no energy at all. Applying adult pads immediately allows the AED to analyze the rhythm and deliver the life-saving shock without losing precious minutes.
Critical Placement and Energy Considerations
When adult pads are used on a child, physical placement requires modification to prevent short-circuiting. Adult pads are significantly larger and risk touching each other if placed in the standard adult anterior-lateral position. If the pads make contact, the electrical current will pass externally across the skin rather than effectively through the heart muscle.
To avoid contact and ensure the current passes through the heart, the placement must be changed to the anterior-posterior configuration. One pad should be placed on the front of the child’s chest, typically over the sternum. The second pad is then placed directly on the child’s back, between the shoulder blades.
Rescuers must be aware that the shock delivered will be the full, unattenuated adult energy dose. This high-energy shock carries an increased risk of myocardial injury or burn injuries to the skin where the pads are applied. However, this potential damage is secondary to the immediate need to restore a perfusing heart rhythm.
Immediate and comprehensive post-defibrillation care is necessary after the delivery of a higher-energy shock. The child will require close monitoring for any signs of heart muscle dysfunction or injury. The priority remains supporting the child’s breathing and circulation until advanced medical professionals arrive and can take over care.