Paediatric defibrillation – A guide to an essential therapy

In the last two decades, emphasis has been placed on early CPR and early defibrillation for successful resuscitation by the world’s major resuscitation organizations. Both of these are crucial elements of the American Heart association’s important concept of the Chain of Survival.  We know that: Sudden cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia occurs in up to 19% of all pediatric out-of-hospital arrests. Note: this is less commonly the presenting rhythm in in children less than 8 years and infants.  In terms of in-hospital-arrests, these ‘shockable rhythms’ (in other words, they respond to electric shocks or defibrillation) are present at some stage of the resuscitation in up to 27% of children, with 10-15% having either of these as the initial arrest rhythm.  The majority of children with sudden cardiac arrest, have experienced this in an out-of-hospital setting and are apnoeic and pulseless on arrival. Most, but not all, have suffered a respiratory arrest leading to asystole  – which is a ‘non-shockable rhythm’, together with pulseless electrical activity. Survival with VF is better than survival with asystole and this survival is directly correlated with minimizing the time to delivery of electric current, with first shock success rate in the region of 90%.  In other words, having a comprehensive understanding of defibrillation is paramount – remember, a chain is only as strong as its weakest link…