Awareness of guidelines for use of automated external defibrillators in children within emergency medical services.

BACKGROUND: Ventricular fibrillation occurs in 10-20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last 5 years, recommendations have been made for the use of automated external defibrillators in children between 1 and 8 years of age. OBJECTIVE: The goal of this study was to determine the awareness of the ILCOR guidelines and statewide protocols concerning AED use in children ages 1-8 among emergency medical providers after new guideline release. Availability of pediatric capable AED equipment was also assessed. METHODS: Surveys were distributed to EMS providers in Iowa and Montana within 1 year of the ILCOR advisory statement in 2003 recommending use of AEDs in children ages 1-8, and again approximately 1 year after the 2005 ILCOR guidelines on cardiopulmonary resuscitation were published. In Iowa, there were concentrated efforts to disseminate information about AED use in children, while there were minimal efforts in Montana. RESULTS: Awareness of ILCOR guidelines for use of AEDs in children was low in both states in 2003 (29% in Iowa vs. 9% in Montana, p<0.001). After release of the 2005 guidelines, awareness improved significantly in both states but was still significantly greater in Iowa (83% vs. 60%, p<0.002). In 2003, less than 20% of respondents in both states reported access to pediatric capable AEDs. Availability of pediatric pads and cables increased significantly in 2006 but remained low in Montana (74% in Iowa vs. 37% in Montana, p<0.001). CONCLUSIONS: At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter must be developed.

Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation.

AIM: To investigate the energy dose used to treat out-of-hospital pediatric ventricular fibrillation and the survival rates of these patients. METHODS: We reviewed three emergency medical systems (EMS) for their reports of patients under 1 month to 18 years who received shocks for ventricular fibrillation to determine the energy of each shock as well as other patient and care characteristics. Each patient's weight was estimated at the age-appropriate 50th and 95th percentiles. Patients were then grouped as receiving recommended energy doses (2 to < or = 4 J/kg), moderately high energy doses (> 4-6 J/kg), and high energy doses (> 6 J/kg). RESULTS: Of 57 patients identified, 54% were male, with a mean age of 11 years, range 2 months to 17 years. Ventricular fibrillation was the initial rhythm in 80% (43/54) of patients. The mean number of shocks delivered was 3, with < or = 2 shocks delivered to 28 (49%) and > or = 5 shocks delivered to 10 (18%) patients. When evaluating all 185 shocks using the 50th percentile estimated weight, 45 (24%) shocks were at recommended doses, 56 (30%) were at moderately high energy doses, and 84 (45%) were high energy doses. Elevated energy dose was associated with an increasing number of shocks and lack of bystander CPR (p < .05). Nineteen (33%) patients survived to hospital discharge having received total doses up to 73 J/kg. Energy dose was not related to survival. CONCLUSION: In this observational, multicenter out of hospital experience, children received a wide range of defibrillation doses, often exceeding recommended doses and equivalent to adult energy levels. Survival occurred at low and very high energy doses.

Automated external defibrillators: safety and efficacy in children and adolescents.

Although children do not suffer from ventricular fibrillation (VF) as frequently as adults, it does occur in 10% to 20% of pediatric cardiac arrests. The technology is available to recognize and treat ventricular fibrillation in children as quickly as we can for adults. This article discusses the evidence to support automated external defibrillator use in young children. As this technology gains increased acceptance, resuscitation rates and outcomes for VF in children should approach those that are seen in adults.