When do you use pediatric paddles

Safety and Prevention. Family Life. Health Issues. Tips and Tools. Our Mission. Find a Pediatrician. Text Size. How to Use an AED. Page Content. What is an AED? You can use adult pads for children 8 years and older. The AAP also encourages having AEDs near school athletic facilities and training so school personnel and older children know how to use them. The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician.

There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Follow Us. However, this has improved in recent years as we strive to improve the results of resuscitation in children. A brief history of defibrillation has recently been provided by Acosta et al. Prevost and Battelle had demonstrated that VF could be induced by a weak alternating current that could then be reversed by a higher intensity current.

From these studies, Kouwenhoven and his colleagues developed the initial alternating current internal defibrillator. Since then, defibrillators have become a mainstay of cardiac arrest treatment. With increasing sophistication, including variable energy dosing, rhythm identification and improved waveforms, their use has extended to out-of-hospital providers.

Adequate current flow through the heart is required for successful defibrillation. There is no parallel relationship between energy and current.

The current delivered to the myocardium with a given energy is dependent on the transthoracic impedance, which can vary widely among patients. Thus, the same energy dose can potentially deliver varying current to a patient. Additionally, the percentage of current shunted through the thorax, away from the myocardium, influences the net current a patient receives. Transcardiac current fraction Fc is the ratio of transcardiac threshold current Ic to transthoracic defibrillator threshold current It.

Transthoracic impedance is a function of tissue properties, electrode surface area, pressure on the electrode and body size. Transcardiac fraction Fc is affected by clinical conditions of the patient, such as pleural effusions, pneumothorax and chest configuration.

Accurate measurement of the current is difficult and cannot be performed in humans. Several theories have evolved to explain the mechanisms of defibrillation. One of the first theories suggested the critical mass theory: defibrillation was successful only when a critical mass of myocardium was made inexcitable. The second theory, theory of vulnerability, was first described by Chen et al. This is achieved by delivering a stimulus that exceeds the upper limit of vulnerability to all regions of the myocardium.

Until the s, monophasic waveforms were used exclusively in defibrillators. Monophasic defibrillators deliver current in one direction whereas biphasic defibrillators deliver current in two directions positive and negative. For biphasic defibrillators, the current flows in one direction during the first phase of the waveform and in the opposite direction during the second phase.

Monophasic defibrillators are typically used according to a protocol of escalating shock energies. In contrast, biphasic waveforms deliver lower energy levels and do not all use escalating energy protocols. Biphasic waveforms have increased the defibrillation efficacy, return of spontaneous circulation ROSC and survival to hospital admission, but, as yet, have not been shown to improve hospital discharge[ 18 — 20 ] In a multicenter, randomized, controlled trial for out-of-hospital cardiac arrest, Schneider et al.

Rates of survival to hospital admission and to hospital discharge did not differ between the groups. There was a trend toward increased hospital discharge, but it was not statistically significant. Conversely, Kudenchuk et al. To date, no study has compared monophasic and biphasic waveforms in children, but several animal studies demonstrate that similar defibrillation efficacy exists. Similar findings were obtained when comparing the 10 ms monophasic waveform to the 10 ms biphasic waveform. However, Kudenchuk et al.

These recommendations are based on extrapolated animal data,[ 25 ] adult data[ 26 , 27 ] and one small retrospective pediatric study. The numbers of shocks, survival, hospital discharge or neurologic outcomes were not reported. All shocks were delivered with monophasic waveforms. This resulted in a much broader range of dosing for infants compared to adolescents, confusing the issue of dosing [ Figure 1 ]. Energy dose versus weight. Closed circles represent unsuccssful shocks and open circles represent successful shocks, defined as termination of ventericular fibrillation.

Size of the circle represents the number of patients modified from Gutgesell, Because of the absence of any additional data in children, no changes have been made to the AHA guidelines for defibrillation.

Those guidelines are based on recommendations established 30 years ago. The use of automated external defibrillators AEDs in children and biphasic waveform has also prompted a review of appropriate dosing. However, most were converted to asystole or pulseless electrical activity. None survived to hospital discharge. Rodriguez-Nunez et al. Rossano et al.

A major drawback in all these studies is that monophasic defibrillators were the primary waveform. One out-of-hospital study using biphasic waveforms doses, at a fixed pediatric dosage 50 J , regardless of weight, demonstrate a high successful defibrillation rate.

This is likely because our conclusions from the prior adult and animal studies underestimated the energy needed for defibrillation. In , Babbs et al. Similarly, Gaba et al. More recently, Berg et al. Myocardial function and damage were assessed by specific hemodynamic parameters, including continuous electrocardiogram ECG and contrast angiographic assessment of LV ejection fraction at 1, 2, 3 and 4 h post-shock.

Tang et al. All piglets were successfully resuscitated with the 50 J shocks without compromise of post-resuscitation myocardial function or survival.

A recent adult study for patients with out-of-hospital cardiac arrest who received greater than one shock compared a fixed, lower energy —— J with escalating, higher energy —— J regimens. In this study, Stiell et al.

There are no studies in children that directly relate pad or paddle size, type or position to successful defibrillation, ROSC or long-term survival. Rather, surrogate endpoints, primarily transthoracic impedance, have been used to determine the correct pad size. Operators can use either hand-held paddles or self-adhesive pads. Multiple studies have demonstrated that paddle or pad size can alter the transthoracic impedance, which may affect the defibrillation success.

The AHA recommends three positions for successful defibrillation. Paddles and electrode pads should be placed on the exposed chest in the anterolateral antero-apical position. Acceptable alternatives to this position are also the anteroposterior paddles and pads and the apex-posterior pads positions. Ideally, the goal is to position the heart between the pads so the current flow through the heart is optimized.

Studies to determine the best position of pads and paddles have only been conducted in adult patients. Garcia and Kerber demonstrated that these three positions had equivalent and acceptable transthoracic impedance in transthoracic defibrillation. Implementation Guide. How-To Videos. How many AEDs should I have? Get Your Site Assesment. Read more. Learn more about requirements below. View State Page.

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