When using an automated external defibrillator on an infant

If an adult or a child is in cardiac arrest (not responsive, not breathing and no pulse), you should begin cardiopulmonary resuscitation (CPR) with chest compressions, and yell for someone to call 911 and get an AED. 

Cardiac arrest can be fatal if not treated within minutes. Survival outside a hospital depends on prompt bystander emergency response.

How to use an AED in an emergency: 

• When then AED is available, continue chest compressions and rescue breathing while someone else turns on the AED and attaches the pads. 

• If the AED says “shock advised," press the charge button, stand clear of the patient, and press the shock button when it lights up. The AED will check the child’s heart rhythm and decide whether or not to deliver a shock. Be sure that no one is touching the child when a shock is delivered.  

• Then resume CPR. It is very important to minimize interruptions of rescue breathing and chest compressions. In addition, when doing chest compressions, lift completely off the chest between compressions to allow for chest recoil.
  

Adult and Pediatric Pads for AEDs:

While all AEDS are made for adults, there are pediatric pads that adjust the energy level used. These pads are for younger children (less than 8 years). 

• You can use adult pads for children 8 years and older. 

• You can use adult pads for a child less than 8 years, but you may have to apply them differently than shown on the pads: apply one on the front of the chest, the other on the back, so they do not touch. See article image. Once the pads are attached, follow the instructions given by the AED.
  

Additional Information:

• Preparing for Sudden Cardiac Arrest in Schools: The Essential Role of AEDs
  

• Sudden Cardiac Death in Young People

• Pediatric Sudden Cardiac Arrest (AAP Policy Statement)

• Sudden Unexpected Death in Young Athletes: Reconsidering 'Hypertrophic Cardiomyopathy (Review article in Pediatrics)​
  

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Objective: Automated external defibrillators (AEDs) have been used successfully in many populations to improve survival for out-of-hospital cardiac arrest. While ventricular fibrillation and pulseless ventricular tachycardia are more prevalent in adults, these arrhythmias do occur in infants. The Scientific Advisory Council of the American Red Cross reviewed the literature on the use of AEDs in infants in order to make recommendations on use in the population.

Methods: The Cochrane library and PubMed were searched for studies that included AEDs in infants, any external defibrillation in infants, and simulation studies of algorithms used by AEDs on pediatric arrhythmias.

Results: There were 4 studies on the accuracy of AEDs in recognizing pediatric arrhythmias. Case reports (n = 2) demonstrated successful use of AED in infants, and a retrospective review (n = 1) of pediatric pads for AEDs included infants. Six studies addressed defibrillation dosages used. The algorithms used by AEDs had high sensitivity and specificity for pediatric arrhythmias and very rarely recommended a shock inappropriately. The energy doses delivered by AEDs were high, although in the range that have been used in out-of-hospital arrest. In addition, there are data to suggest that 2 to 4 J/kg may not be effective defibrillation doses for many children.

Conclusions: In the absence of prompt defibrillation for ventricular fibrillation or pulseless ventricular tachycardia, survival is unlikely. Automated external defibrillators should be used in infants with suspected cardiac arrest, if a manual defibrillator with a trained rescuer is not immediately available. Automated external defibrillators that attenuate the energy dose (eg, via application of pediatric pads) are recommended for infants. If an AED with pediatric pads is not available, the AED with adult pads should be used.

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