TECHNICAL REPORT

Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1368-e1379 (doi:10.1542/peds.2007-2679)
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TECHNICAL REPORT

Ventricular Fibrillation and the Use of Automated External Defibrillators on Children

David Markenson, MD, Lee Pyles, MD, Steve Neish, MD and the Committee on Pediatric Emergency Medicine and Section on Cardiology and Cardiac Surgery

ABSTRACT

The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.

Key Words: automated external defibrillator • ventricular fibrillation • emergency medical services • cardiac resuscitation • school emergency care

Abbreviations: VF—ventricular fibrillation • AED—automated external defibrillator • EMS—emergency medical services • CPR—cardiopulmonary resuscitation • PEA—pulseless electrical activity • VT—ventricular tachycardia • ALS—advanced life support • DFT—defibrillation threshold • ED50—median effective dose • TD50—median toxic dose • LD50—median lethal dose • LV—left ventricular • LOE—level of evidence