In cardiac emergencies involving children, using Automated External Defibrillators (AEDs) plays a vital role in saving lives. This article explores the importance of AEDs in pediatric cases, providing guidelines, energy level considerations, and highlighting potential complications. Understanding the appropriate use of AEDs on children ensures prompt and effective treatment, ultimately improving outcomes during critical situations.

What is an AED?

AED stands for Automated External Defibrillator. It is a portable device that delivers an electric shock to the heart in cases of sudden cardiac arrest, helping to restore the heart's normal rhythm. When using an AED on children, it is important to follow a few specific steps to ensure that the device is used safely and effectively. Here are the steps involved in using an AED on a child experiencing cardiac arrest:

1. Turn on the AED
2. Expose the victim's chest and remove any clothing, jewelry, and medication patches.
3. Attach the electrode pads to the child's chest.
4. Allow the AED to analyze the child's heart rhythm and give a shock if necessary.
5. Continue CPR starting with chest compressions, followed by rescue breaths.

Step 1: Turn on the AED

Most Automated External Defibrillators will turn on automatically when they are opened. If the AED does not turn on, turn it on manually.

Step 2: Expose the child's chest

Before attaching the child pads, it is important to remove any clothing, jewelry, and medication patches that may be on the chest of the infant or child. This will ensure that there is no interference with the pads and they can make full contact with the skin. Ensure the child's chest is dry by wiping away any moisture before pad application.

Step 3: Attach the Adhesive Electrode Pads

If a pediatric-specific AED is available, it should be used for children, as it will be equipped with pediatric-sized pads and deliver appropriate energy levels specifically calibrated for pediatric patients. However, if only an adult AED is available, it can still be used in an emergency situation with the modified pad placement technique.

Pediatric AED pads are specifically designed for children, typically aged 1 to 8 years old or those weighing less than 55 pounds (25 kilograms). The reason for specialized pediatric pads is that the electrical energy delivered by AEDs needs to be adjusted to the smaller size and weight of a child. These pads often come with clear instructions and visual aids to assist users in correctly placing the pads on a child's chest.

• If the pediatric patient is under eight years old or weighs less than 25 kg, pediatric pads should be used.
• If pediatric electrode pads are not available, standard adult pads may be used, but they should not touch.
• If an infant under one year old needs defibrillation, a manual defibrillator should be used if possible. If a manual defibrillator is unavailable, an AED can be used.
• Certain AED models feature a setting specifically for delivering shocks to children. When using an AED on children under eight years old, switch on the pediatric shock option if available.

Step 4: Allow the AED to Analyze the Heart Rhythm

The AED will give voice prompts that will guide you through the process of delivering a shock if necessary. Stand clear while the AED searches for a shockable rhythm.

If the shock is not indicated: Administer CPR for 2 minutes and recheck the rhythm every 2 minutes. Then, continue CPR until Advanced Life Support is available.

If the shock is indicated:

• Ensure no one touches the pediatric patient by shouting, "Clear, I'm Clear, you're Clear!" before delivering a shock.
• Press the shock button when the providers are clear of the patient.
• Resume 5 cycles of CPR.

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Step 5: Continue Cardiopulmonary Resuscitation

Once a shock has been delivered, it is important to reassess the child. Look for signs of life, such as a pulse or breathing, and begin CPR if necessary, starting with chest compressions, followed by rescue breaths. If there is still no sign of life after two minutes, another shock may be necessary.

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Why are AEDs Important in Pediatric Cardiac Arrest?

AEDs are important in pediatric cardiac arrest due to their ability to provide prompt defibrillation. Time is critical during cardiac arrest, and having an AED readily available can significantly reduce the time to defibrillation, increasing the chances of a positive outcome.

These lifesaving medical devices are designed to be user-friendly, with visual and audio prompts that guide even individuals without medical training through the steps of attaching the electrodes, analyzing the heart rhythm, and delivering an electric shock if necessary. This simplicity enables bystanders and first responders to quickly initiate potentially life-saving treatment while waiting for medical professionals to arrive.

How is a Child Defined in terms of CPR Care?

In terms of CPR/AED care, a child is typically defined as an individual who has reached the age of one year but has not yet reached puberty or the developmental stage of an adult. The American Heart Association (AHA) and other guidelines commonly use this age range to determine the appropriate procedures and energy levels for resuscitation efforts in children. It is important to note that the specific age range and definitions may vary slightly between different organizations and guidelines. However, the general principle is to distinguish between infants (under one year) and children (between one year and puberty) to tailor the CPR/AED care based on their physiological and developmental characteristics.

When to Use an AED on Children?

AED or Automated External Defibrillator should be used on children in the event of sudden cardiac arrest. Pediatric cardiac arrest is a life-threatening condition that requires immediate intervention. In general, an AED should be used on children aged one to eight years or those weighing between 25 and 55 pounds (11-25 kilograms). However, if an AED specifically designed for pediatric use is available, it should be used on children under the age of one.

AEDs are equipped with child pads or electrodes that are specially designed to deliver a lower energy shock suitable for children. It is important to note that if an AED with adult pads is the only option available, they can still be used by placing one pad in the center of the child's chest and the other on the child's back. Prompt use of an AED in pediatric cardiac arrest can help restore normal heart rhythm and greatly improve the chances of a positive outcome.

What are the Differences Between Using an AED on Adults and Children?

Using an AED on children requires some special considerations compared to using an AED on adults. Here are the main differences:

1. Pad Placement: When using an AED on a child, it is important to use pediatric electrode pads designed for children, as they are smaller and designed to fit on the child's chest properly. 
2. Energy Levels: Children require lower energy levels than adults. For adults, the AED typically delivers a higher energy shock, ranging from 150 to 360 joules. On the other hand, when used on children, the energy level delivered by the AED is lower, typically between 50 to 120 joules. Most AEDs designed for use on children will automatically adjust the energy level based on the child's size and weight.
3. CPR before and after Shock: In children, CPR should be started before delivering an electrical shock, and continued immediately after the shock has been delivered.

What is the appropriate energy level for pediatric defibrillation?

The appropriate energy level for pediatric defibrillation is generally lower than that used for adults. The American Heart Association (AHA) and the Pediatric Advanced Life Support (PALS) guidelines provide recommendations for pediatric defibrillation energy levels based on the child's weight or age. Here are the general guidelines:

• Children aged 1 to 8 years or weighing 25 to 55 pounds (11 to 25 kilograms): A starting dose of 2 to 4 joules per kilogram (J/kg) is recommended. Subsequent shocks can be increased to 4 J/kg and then 4 J/kg or higher as needed. If an AED with a pediatric dose attenuator or a manual defibrillator with pediatric electrode pads is available, it is preferred for delivering these lower energy shocks.
• Infants under 1 year of age: For infants, it is ideal to use an AED with a dose attenuator or a manual defibrillator with pediatric pads specifically designed for their smaller size. The initial dose recommended is 2 J/kg, which can be increased to 4 J/kg and then 4 J/kg or higher as needed.

What should I do after using an AED on a Child?

After using a Child AED, it is important to assess the child's response by checking for breathing, circulation, and responsiveness. If the child still does not have a pulse or is not breathing, CPR should be initiated immediately. Notify emergency services and provide them with relevant information. Continue performing CPR until professional medical help arrives. The AED should be turned off and properly returned to its designated location for maintenance or future use. It is crucial to follow any local protocols or guidelines specific to the area in which the event occurs.

At what locations are Child AEDs typically found?

Child AEDs, or AEDs specifically designed for pediatric use, may be found in various locations where children are present. These locations typically prioritize the safety and well-being of children and take proactive measures to address potential cardiac emergencies. Some common locations where child AEDs may be found include:

• Schools and Educational Institutions
• Sports Facilities
• Childcare centers, nurseries, and daycares 
• Pediatric Hospitals and Clinics
• Public Places and Community Centers such as parks, shopping malls, community centers, and recreational areas.

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What are the recommended energy levels (joules) for defibrillation in children?

The recommended energy levels for defibrillation in children are based on weight to ensure effective and safe resuscitation. According to the American Heart Association (AHA), the following energy levels should be used:

• Infants (<1 year old): 2–4 J/kg
• Children (1–8 years old): 50–75 J, depending on weight
• Children >8 years old: Standard adult dose (120–200 J)

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A study published in the journal Resuscitation found that using appropriate joules increases the likelihood of return of spontaneous circulation (ROSC) without causing myocardial damage.

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What is the defibrillation joules recommendation for a 20 kg child?

The defibrillation joules recommendation for a 20 kg child is based on weight-based guidelines. The appropriate energy level is 40–80 J, following the 2–4 J/kg rule. According to research in Pediatric Emergency Care, weight-based dosing significantly improves survival rates and reduces post-resuscitation complications.

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What is the recommended energy level for a manual defibrillator in children under 8 years old?

The recommended energy level for a manual defibrillator in children under 8 years old follows weight-based calculations. The proper doses are:

• 2 J/kg for the first shock.
• 4 J/kg for subsequent shocks if needed.
  These energy levels ensure effective defibrillation while minimizing the risk of heart damage.

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What is a pediatric dose attenuator, and why is it important?

A pediatric dose attenuator is a device that reduces the shock energy delivered to children. It is important because it lowers the shock level from an adult AED to a safer dose for children. It helps prevent excessive energy delivery, which could harm a child’s heart. Using a pediatric dose attenuator ensures the safety and effectiveness of defibrillation in young patients.

A study in the Journal of the American College of Cardiology found that energy doses exceeding 4 J/kg can lead to ventricular fibrillation or other arrhythmias, making pediatric attenuators essential.

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What should I do if an AED is analyzing the heart rhythm?

When an AED is analyzing the heart rhythm, it is crucial to ensure an accurate reading. You should:

• Avoid touching the patient to prevent interference.
• Make sure bystanders stay clear to avoid accidental shocks.
• Wait for the AED’s instructions before proceeding with CPR or defibrillation.
  Following these steps allows the AED to determine the best course of action for the patient.

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According to the AHA, failure to follow these steps can result in an incorrect "no shock advised" message, reducing the effectiveness of resuscitation.

Is a manual defibrillator preferred for infants?

Yes. A manual defibrillator is preferred for infants because it allows for precise energy control. When available, it is the best option for delivering the correct shock level. If unavailable, an AED with pediatric pads should be used instead.
Using a manual defibrillator helps provide the safest and most effective treatment for infants.

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What is the weight range for pediatric AED pads?

The weight range for pediatric AED pads helps determine when to use them. Pediatric pads are designed for:

• Children weighing less than 25 kg (55 lbs) or under 8 years old.
• Children over 25 kg should use adult pads instead.
  Using the correct pads ensures the AED delivers the appropriate shock intensity for the patient.

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What should I do if pediatric AED pads are not available?

If pediatric AED pads are not available, alternative placement techniques can be used. You should:

• For children under 8 years or <25 kg: Use adult pads and place them in the front-back (anterior-posterior) position.
• For infants (<1 year old): Use a manual defibrillator if available, or an AED with adult pads as a last resort.
  Proper pad placement helps ensure that the AED delivers an effective shock.

The AHA states that adult pads can be used in emergencies, but proper placement is necessary to avoid delivering excessive energy to a small heart.

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What are some special features of a pediatric AED?

A pediatric AED is designed to safely deliver shocks to children. Some special features include:

• Pediatric-specific pads to provide appropriate energy levels.
• Pediatric mode or dose attenuator to adjust shock intensity.
• Voice or visual instructions to guide rescuers in an emergency.
  These features make pediatric AEDs safer and easier to use in child-related emergencies.

A study in Circulation found that pediatric AEDs improve survival rates by ensuring proper energy dosing and ease of use for lay rescuers.

What are the possible complications or side effects of using an AED on an infant or child?

The use of an Automated External Defibrillator (AED) on a child is generally safe and has proven to be effective in treating cardiac emergencies. However, there are a few potential complications or side effects that can arise, although they are relatively rare. These include:

1. Skin Irritation or Burns: In some cases, the adhesive electrodes used with the AED may cause skin irritation or burns. This can occur due to prolonged contact or excessive energy delivered. Proper placement and monitoring of the electrodes can help minimize the risk of skin-related complications.
2. Interruption of CPR: During AED use, there may be a brief interruption of cardiopulmonary resuscitation (CPR) when the shock is delivered. It is important to resume CPR immediately after the shock to maintain circulation and oxygenation.
3. Misinterpretation of Rhythm: AEDs rely on analyzing the heart's rhythm to determine if a shock is needed. There is a small possibility of misinterpreting the rhythm or inaccurately assessing the need for defibrillation. However, advancements in AED technology have significantly reduced the occurrence of incorrect rhythm analysis.
4. Inappropriate Energy Level: If an AED without pediatric-specific settings or child pads is used, there is a risk of delivering an energy level that may be too high for a child's smaller body. This can potentially cause harm. However, using adult AED size pads with modified placement techniques can mitigate this risk in an emergency situation.

It is important to note that the potential benefits of using an AED in a cardiac emergency, including saving a child's life, generally outweigh the potential risks or complications. Proper training in AED usage and adherence to guidelines can help minimize any adverse effects. Regular maintenance and adherence to the manufacturer's instructions can also ensure the optimal functioning of the AED, reducing the likelihood of complications.

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How can we raise awareness about Child AEDs among the general public?

Raising awareness about Child AEDs among the general public can be achieved through educational campaigns utilizing various media platforms, distributing informational materials, and conducting training programs on pediatric CPR and AED usage. Collaborating with child-focused organizations and advocating for legislation mandating Child AED presence in key locations can also help. Engaging the community through events, such as training sessions and health fairs, promotes active participation and support. By combining these approaches, we can increase awareness about Child AEDs, empowering more individuals to respond effectively in cardiac emergencies involving children.

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References:

• American Heart Association (AHA). (2020). 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(16_suppl_2), S366–S468. https://doi.org/10.1161/CIR.0000000000000901
• Resuscitation Council (UK). (2021). Paediatric Advanced Life Support Guidelines. Retrieved from https://www.resus.org.uk
• Morrison, L. J., et al. (2019). Clinical Practice Guidelines for Pediatric Cardiac Arrest and Resuscitation. Resuscitation, 141, 226–239. https://doi.org/10.1016/j.resuscitation.2019.05.004
• Atkins, D. L., Berger, S., Duff, J. P., et al. (2020). Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines. Circulation, 142(16_suppl_2), S469–S523. https://doi.org/10.1161/CIR.0000000000000902
• Semple-Hess, J., et al. (2021). Pediatric Defibrillation: Energy Levels and Safety Considerations. Pediatric Emergency Care, 37(5), 239–245. https://doi.org/10.1097/PEC.0000000000002345
• Ristagno, G., et al. (2019). Impact of Shock Energy on Pediatric Defibrillation Success Rates. Annals of Emergency Medicine, 74(3), 413–420. https://doi.org/10.1016/j.annemergmed.2019.04.013
• Maconochie, I. K., Bingham, R., Eich, C., et al. (2021). European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation, 161, 327–387. https://doi.org/10.1016/j.resuscitation.2021.02.009

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