Sudden Cardiac Arrest (SCA) is one of the leading causes of death all around the world.[1] As cardiac arrest occurs without any warning, the time for resuscitation is vital. Untimely treatment is likely to result in respiratory distress, loss of consciousness, and even death of the patient. Therefore, timely resuscitation is crucial to save lives and reduce damages. Usually, CPR and defibrillation are considered to be the most effective solutions for SCA rescue.
The process of using a defibrillator to deliver a high-energy electrical shock to the heart of a patient with SCA via the chest can effectively terminate ventricular fibrillation (VF), thereby helping to restore a regular rhythm. This is what we call defibrillation. AED is such a portable defibrillator designed for bystanders without a medical background to help out-of-hospital cardiac arrest patients (OHCAs) receive timely and effective defibrillation. AED use for cardiac arrest patients is self-explanatory.
Unfortunately, SCA does not just happen to adults but to children and infants as well. Given that, some people may wonder if such a high-energy shock is suitable for infants and children. Can we use AED devices on an infant or child?
AED for an Infant and Child
Studies have shown that for an infant or child with SCA, the most effective method to maximize the chances of survival is also through early CPR and defibrillation. [2] If a manual defibrillator and professional rescuers are not available in an emergency situation, an automated external defibrillator is the best option.[2] Generally, there’s little difference in applying AED on an adult or child; only infants or children under 8 years old or lighter than 55 pounds need a pediatric mode and pediatric AED pads.
The reasons behind it are that the shock energy they require is much lower than that required by adults, and an AED machine with a pediatric mode reduces the output shock energy without causing side effects of burns or myocardial dysfunction in infants and children. In addition, AED pads for adults are not suitable for infants and children because of their size, while pediatric pads serve the same purpose as standard adult pads but are great for achieving a lower energy shock output. If pediatric pads are not available in an emergency, standard adult pads are acceptable, but make sure they are not touching.[1]
How to Use AED on an Infant and Child?
Since automated external defibrillators can be used on infants and children, how to use an AED on them? In fact, the steps for using an AED device on a child and an adult are roughly the same, but there are still slight differences.
1. Check the AED equipment
When you get an AED device in good condition, turn it on and check for the availability of the machine and accessories. Do not forget to check if the AED device is equipped with pediatric AED pads. If not, consider replacing one or opting to use standard adult pads. If the AED device is available, follow the voice prompts for the next step.
2. Place the AED pads
Place the infant or child with SCA on a hard and flat surface, undress the patient and ensure that his/her chest is dry and free of any medication patches. Place the pediatric AED pads in the correct position according to voice and visual image prompts.
For children and infants under 8, AED pad placement differs from that of an adult. It should follow the rules for anteroposterior AED pad placement, i.e., place one pad in the middle of the child’s or infant’s chest and the other on the back directly opposite. For the AED pad placement, some AED brands (such as Mindray AED) will provide simple picture instructions on their pediatric AED pads to help responders quickly find the exact location and launch a smooth rescue.
3. Analyze the heart rhythm
When the pediatric AED pads are in the correct position and the circuit is connected, the AED machine will automatically analyze the electrical activity of the patient’s heart to see if there are any defects in the heart rhythm. If the AED device detects an abnormal heart rhythm and qualifies for an AED shock, it will issue a recommendation for a shock.
4. Deliver the shock
After the shock recommendation, you will be asked to step back and ensure that no one is touching the patient. When the conditions for AED shock delivery are available, the AED automatically delivers the shock. However, if you are using a semi-automatic AED, you are required to press the shock button in the middle of the machine to release the AED shock.
5. Perform CPR
After the shock is delivered, the AED machine will instruct you to perform CPR on the patient for two minutes. The steps for performing CPR on infants and children are not the same as those for adults.
For children, use the one-handed CPR technique, which involves placing the heel of one hand in the center of the child’s chest and pushing down hard and fast at a rate of 100 to 120 times per minute for about 2 inches.
For infants, simply use two fingers (side by side) to find the center of the chest below the line between the nipples and push down 1.5 inches at 100 strokes per minute.
Give sets of CPR (30 chest compressions and 2 breaths) until the patient begins to breathe, cough, or open his or her eyes. Keep the defibrillator on in case another shock is needed; otherwise, continue CPR until EMS arrives on the scene.
AED use has been proven to be appropriate and safe for infants and children with SCA and can effectively improve the chance of survival. Nowadays, AEDs are suggested to be installed in homes, businesses, and other public places to be ready for such emergencies of SCA. With this in mind, AED devices are best chosen with a child mode and equipped with pediatric AED pads that can safely and effectively defibrillate children and infants under the age of 8.
Mindray is currently one of the few AED providers on the market that has mastered advanced defibrillation technology. Its AED devices not only have child mode and pediatric AED pads but also provide interactive voice and image guidance based on ResQNavi technology to make them user-friendly and easy to use. Moreover, it can automatically switch the appropriate mode according to the connected AED pads, so responders have no need to worry about forgetting to switch modes because of panic. Most importantly, Mindray AED can be pre-set to output shock energy for safer defibrillation of infants and children, which is the best choice for those who need to defibrillate infants and children.
If you are considering an AED device with adult and child modes, then you may want to consider the user-friendly and cost-effective Mindray AED.
References:
[1] European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. Volume 161, February 2021, Pages 61–79. Available at: https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-Ep.pdf (Accessed: 21 February 2022)
[2] The Use of Automated External Defibrillators in Infants: A Report From the American Red Cross Scientific Advisory Council. Pediatr Emerg Care. 2015 Jul, Volume 31, Issue 7, Page 526-530. Available at: https://pubmed.ncbi.nlm.nih.gov/26148104/ (Accessed: 21 February 2022)