What is the optimal paddle force during paediatric external defibrillation?

Area of Science:

• Pediatric Cardiology
• Emergency Medicine
• Biomedical Engineering

Background:

• Transthoracic impedance (TTI) significantly impacts defibrillation success in children.
• Current European Resuscitation Council (ERC) guidelines recommend firm paddle force but lack age-specific optimal force data.
• No prior studies have established optimal paddle force to minimize TTI in pediatric patients.

Purpose of the Study:

• To determine the optimal paddle force required to minimize transthoracic impedance (TTI) in pediatric patients of varying ages.
• To establish evidence-based recommendations for paddle force during pediatric defibrillation.
• To inform updates to resuscitation guidelines for pediatric defibrillation.

Main Methods:

• Eighty pediatric patients (10 weeks to 17 years) undergoing general anesthesia were studied.
• Transthoracic impedance (TTI) was measured using defibrillation paddles at varying forces (0.5 kgf to 6.5 kgf).
• Optimal force was defined as the force achieving 95% of the overall TTI reduction, calculated for infants and different age groups of older children using appropriate paddle sizes.

Main Results:

• Increasing paddle force progressively reduced TTI in all pediatric age groups.
• Optimal paddle force was 2.9 kgf for infants (< or =10 kg) using paediatric paddles.
• Optimal paddle force was 5.1 kgf for children (>10 kg and < or =8 yrs) and 5.3 kgf for older children (9-17 yrs) using adult paddles.

Conclusions:

• Paddle force is a critical factor influencing TTI and defibrillation outcomes in children.
• A minimum of 3 kgf paddle force is recommended for infants using paediatric paddles.
• A minimum of 5 kgf paddle force is recommended for all older children when using adult paddles.