Pediatirc AED Defibrillation

[ResTech]

My department just purchased the new electrodes for our LP500's that allow use on pediatric patients (<8 y/o to infant). They work by employing a "transducer" on the electrodes to reduce the delivered energy from the AED.

We are the only department in my county that has this capability. Does anyone else have this ability with AED? Granted it will be used very infrequently but is nice to have the extra capability to treat kids at the BLS level.

 

[MMiz]

Originally posted by ResTech@Jun 5 2004, 12:59 PM
My department just purchased the new electrodes for our LP500's that allow use on pediatric patients (<8 y/o to infant). They work by employing a "transducer" on the electrodes to reduce the delivered energy from the AED.

We are the only department in my county that has this capability. Does anyone else have this ability with AED? Granted it will be used very infrequently but is nice to have the extra capability to treat kids at the BLS level.

The national registry does doesn't want AEDs being used on Peds, I'd be interested to see how they react to this new innovation in AEDs. In fact this is the first I've heard of such a device. It's interesting though, I'll keep an eye on it.

Thanks for sharing!

 

[ffemt8978]

I haven't seen any thing come through the American Heart Association about pediatric AED's yet. I wonder what their take will be on it, since they pretty much set the standard for CPR and AED usage.

 

[ResTech]

Pennsylvania recently published brand new medical protocols for BLS providers that include a provision for pediatric defibrillation. ALso, the AHA has recommended the use of AED's on pediatric patients aged 1-8 years old. I found the below article from the AHA that should be very informative.
______________________________________________
American Heart Association scientific statement:
RELEASED June 30, 2003

American Heart Association says AEDs safe to use on children ages 1 to 8
DALLAS, July 1 – Automated external defibrillators (AEDs) – devices that shock the heart to restore a normal heartbeat after a life-threatening irregular rhythm – are safe for children as young as age 1, according to an American Heart Association scientific statement published today in Circulation: Journal of the American Heart Association.

“AEDs are the first line of treatment for cardiac arrests in adults. Until recently, they were only approved for people age 8 and older,” says Ricardo Samson, M.D., associate professor of pediatrics, University of Arizona, Tucson, and lead author of the statement. Prior to this statement, children under age 8 could receive manual defibrillation at a hospital but were excluded from the automated machines designed for use by emergency personnel, or even lay responders outside of a hospital. “Typically, a child in cardiac arrest would have to wait for experienced medical personnel to evaluate if the rhythm required a shock,” he says. “What has been shown in adults is that the earlier they receive a shock, the greater the chances of survival. For every minute that defibrillation is delayed, survival decreases by 7 percent to 10 percent. If it’s delayed by more
than 12 minutes, the chance of survival in adults is less than 5 percent.”

There is no specific data, but pediatric cardiac arrests occur much less often than adult cardiac arrests, Samson says. “But in those cases where it’s necessary, AEDs can save a young person’s life. Extending their use to younger children may mean more children’s lives may be saved.” Ventricular fibrillation is an extremely fast and chaotic heart rhythm during which the heart’s lower chambers (ventricles) quiver and don’t pump any blood. AEDs diagnose heart rhythms, differentiating those that need a defibrillating shock from those that don’t. The devices can be
operated by bystanders or emergency responders such as paramedics or police officers.

AEDs were originally designed for adults, but they now have been shown to also accurately diagnose a child’s heart rhythm. Some AED manufacturers now offer pediatric-sized electrode pads with cables that reduce the adult-size shock to a level more suitable to children 1 to 8. “With that information, we are issuing the statement that AEDs can now be used on children with no signs of circulation as young as 1 year of age,” Samson says. However, even an AED without pediatric electrode pads can be used on children 1 and older Authors of the statement include pediatric specialists in intensive care, cardiology and
anesthesia. Their review of the literature on AED use in children also reaffirms previous recommendations that:

• there is insufficient evidence to suggest that AEDs be used in children younger than age 1;
• rescuers working alone should first try a minute of cardiopulmonary resuscitation (CPR) before any other action on children, because some unconscious children may be revived
by rescue breaths alone if they are not suffering a cardiac problem; and
• defibrillation is recommended for documented ventricular fibrillation.
There is a widespread misconception that smaller children should get proportionately lower shock doses. But the research suggests that children might need higher doses than what was previously thought for effective defibrillation, Samson says. More research is needed to determine the optimum dose in children, he says. “We encourage manufacturers to test their rhythm detection software in their AEDs against ‘libraries’ of previously recorded pediatric rhythms. That provides information on the device’s accuracy for determining if a shock should be delivered to a child or not,” he says. AEDs are often available in public places where large numbers of people might gather such as airports, theaters, casinos and sports stadiums. People trained to use them can include non-
medical personnel who have been designated to respond with the devices should someone collapse. “It’s important that more people are trained in CPR and AED use. Site-specific response plans must also be in place to ensure that an AED gets to the victim,” Samson says. “There have been situations reported where an AED was available but a child died because there was no one trained to retrieve and use the device.”


Statement co-authors are: Robert A. Berg, M.D.; Dominique Biarent, M.D.; Bob Bingham, MBBS; Ashraf Coovadia, M.D., Mary Fran Hazinski, R.N.; Robert W. Hickey, M.D.; Vinay
Nadkarni, M.D.; Graham Nichol, M.D. M.P.H.; Amelia Reis, M.D.; Jim Tibballs, MBBS; Sandy
Tse, M.D.; David Zideman, MBBS ; Jerry Potts, Ph.D.; Karen Uzark, Ph.D. and Diane Atkins,
M.D.
The statement will also published in Pediatrics and Resuscitation

 

[Chimpie]

Okay, so does one need to purchase pediatric pads or not? The story says both.

Chimp

 

[Chimpie]

I couldn't find anything about this on Medtronic's website.

Chimp

 

[ResTech]

Yes, pediatric electrodes are required for defibrillation on children 1-8 years of age. Research is still undergoing regardlng the exact energy dose needed for this age group however, studies so far point to an energy level below what is required for adults.

This is why I think the recommendation was made for use of standard "adult" AED electrodes in the absence of specialized pediatric electrodes but they are not recommended for standard delivery of defibrillation to pediatric patients. There is no clear or factual evidence that say's adult energy doses are detrimental to the 1-8 year old age group.

Here is a link to a news release on Med-tronics website announcing the availability of the pediatric electrodes.

http://www.medtronic.com/newsroom/news_20030210a.html

 

[Chimpie]

Good find ResTech. We use the CR Plus. Looks like I'll be doing a little more research and possibily writing a proposal next week.

Chimp

 

[ResTech]

Just glad I could help and spread the word about this new treatment for children.

 

[MMiz]

Great contribution. I'm not sure the company I work for would go out and purchase these right away, but it's definitely something to keep an eye on.

Thanks!

 

[sunshine1026]

We also recently got the pediatric pads for the AED, but (fortunately) haven't had an occasion to use them yet.

 

[rescuemedic7306]

I'm an AHA BLS instructor and I know they are having a big ol' conference next month concerning all the guidelines. They currently endorse ped pads and include using adult pads as an alternative, since once your dead, anything is better than nothing. The ped AED guidelines will be issued with the next update. Even more spectacular is the rumor/news that the ABCs are likely to get a shakeup since new research suggests that people in cardiac arrest actually have sufficient O2 in their blood to provide up to 10 minutes of oxygenation to the brain, therefore C, as in circulation, aka compressions is the first thing that should be established. (Cue gasps of horror and gnashing of teeth!). The new guidelines are not likely to actually be published until next year, but we have an instructor update in June when we will get the lowdown. :blink:

 

[Jon]

rescue medic, you hit the nail on the head... the ABC's ebate was THE argument at EMS Today.

It will be intresting to see the final 2005 guidelines from the upcoming meeting.

The last time 'round was 2000.


This meeting is why I've not bought any instructor materials yet for CPR.


Jon

 

[rescuecpt]

We have the peds pads for the AED and the Lifepak12.

Even more spectacular is the rumor/news that the ABCs are likely to get a shakeup since new research suggests that people in cardiac arrest actually have sufficient O2 in their blood to provide up to 10 minutes of oxygenation to the brain, therefore C, as in circulation, aka compressions is the first thing that should be established.

This has actually been around for quite a while.. in Europe they were doing studies that showed doing about 400 compressions right off the bat then starting rescue breathing actually had better results than doing both.

Also, when i did my clinicals in the OR for my ALS class, I was talking to the anesthesiologist about how we have 30 sec. to get the tube, if not we have to bag and then try again - he said something along the lines of "you field providers are so silly, you've got a good 6 - 8 minutes before you start doing any damage".

 

[Jon]

Originally posted by rescuecpt@Apr 27 2005, 12:49 PM
"you field providers are so silly, you've got a good 6 - 8 minutes before you start doing any damage".

2 things.

1- Anesthesia always thinks we are silly. Trying to intubate under a coffee table, or in a wrecked car, on its roof, at 3 am of the worlds' worst blizzard. :lol:

2- If only NR would give you more than 30 seconds to get the tube

 

[rescuecpt]

Originally posted by MedicStudentJon+Apr 27 2005, 01:00 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Apr 27 2005, 01:00 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt@Apr 27 2005, 12:49 PM
"you field providers are so silly, you've got a good 6 - 8 minutes before you start doing any damage".

2 things.

1- Anesthesia always thinks we are silly. Trying to intubate under a coffee table, or in a wrecked car, on its roof, at 3 am of the worlds' worst blizzard. :lol:

2- If only NR would give you more than 30 seconds to get the tube [/b][/quote]
I know... and imagine that statement with a thick indian accent.

 

[Phridae]

Originally posted by rescuemedic7306@Apr 27 2005, 11:58 AM
I'm an AHA BLS instructor and I know they are having a big ol' conference next month concerning all the guidelines. They currently endorse ped pads and include using adult pads as an alternative, since once your dead, anything is better than nothing. The ped AED guidelines will be issued with the next update. Even more spectacular is the rumor/news that the ABCs are likely to get a shakeup since new research suggests that people in cardiac arrest actually have sufficient O2 in their blood to provide up to 10 minutes of oxygenation to the brain, therefore C, as in circulation, aka compressions is the first thing that should be established. (Cue gasps of horror and gnashing of teeth!). The new guidelines are not likely to actually be published until next year, but we have an instructor update in June when we will get the lowdown. :blink:

yeah yeah yeah!!

www.callandpump.com

Ha, AHA CPR? Not around here. Its CCR.

We have had a significant increase in survival since we started using CCR.

www.callandpump.com GO LOOK!!

Find someone unconscious? Check for a pulse. No pulse, 100 compressions a minutes right away. Thats all you do. And yell for someone to call 911. Unless you're the only one there. Call 911 first, then pump. Voila!

 

[rescuecpt]

Wow, Phridae, you're quite excited about that.

 

[Phridae]

I am. Its so easy to learn and the survival rate is really high. I'm glad that more people are hearing about it. Alost every squad in walworth county in Wisconsin is doing it. Somewhere in Arizona its being taught and used too. Seriously, bring it up at a meeting or something, its worth it.

Call and Pump.

 

[Jon]

Originally posted by rescuecpt+Apr 27 2005, 01:29 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Apr 27 2005, 01:29 PM)</td></tr><tr><td id='QUOTE'>

Originally posted by MedicStudentJon@Apr 27 2005, 01:00 PM
<!--QuoteBegin-rescuecpt

@Apr 27 2005, 12:49 PM
"you field providers are so silly, you've got a good 6 - 8 minutes before you start doing any damage".

2 things.

1- Anesthesia always thinks we are silly. Trying to intubate under a coffee table, or in a wrecked car, on its roof, at 3 am of the worlds' worst blizzard. :lol:

2- If only NR would give you more than 30 seconds to get the tube

I know... and imagine that statement with a thick indian accent. [/b][/quote]
yep. Pegs the one guy I was thinking of perfectly. the other one that comes to mind has a slight middle-eastern accent.

:lol:

jon