ACCURATE RECOGNITION AND EFFECTIVE TREATMENT OF VENTRICULAR-FIBRILLATION BY AUTOMATED EXTERNAL DEFIBRILLATORS IN ADOLESCENTS

Objectives. To evaluate the accuracy and efficacy of automated externa l defibrillators (AEDs) in patients <16 years old. Background. AEDs ar e standard therapy in out-of-hospital resuscitation of adults and have led to higher success rates. Their use in children and adolescents ha s never been evaluated, despite recommendations from the American Hear t Association that they be used in children >8 years of age. Methods. This was a retrospective cohort study of children <16 years old who un derwent out-of-hospital cardiac resuscitation and on whom an AED was u sed during the resuscitation. The setting was rural and urban prehospi tal emergency medical systems. Patients were identified by review of a database of cardiac arrests maintained by a large surveillance progra m of these services. Results. AEDs were used to assess cardiac rhythm in 18 patients with a mean age of 12.1 +/- 3.7 years. The cardiac rhyt hms were analyzed 67 times and included ventricular fibrillation (25), asystole/pulseless electrical activity (32), sinus bradycardia (6), a nd sinus tachycardia (4). The AEDs recognized all nonshockable rhythms accurately and advised no shock. Ventricular fibrillation was recogni zed accurately in 22 (88%) of 25 episodes and advised or administered a shock 22 times. Sensitivity and specificity for accurate rhythm anal ysis were 88% and 100%, respectively. One patient with a nonshockable rhythm survived, whereas 3 of 9 patients with ventricular fibrillation survived. Conclusions. These data furnish evidence that AEDs provide accurate rhythm detection and shock delivery to children and young ado lescents. AED use is potentially as effective for children as it is fo r adults.