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Is optimal paddle force applied during paediatric external defibrillation?
Sarah H Bennetts1, Charles D Deakin, Graham W Petley
1Shackleton Department of Anaesthetics, Southampton University Hospital NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
Insights
Healthcare providers often apply suboptimal paddle force during pediatric defibrillation. This study found that forces applied to infant and child manikins were frequently below recommended levels, potentially impacting defibrillation success.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Resuscitation
- Medical Device Usability
Background:
- Transthoracic impedance affects defibrillation success; optimal paddle force minimizes this.
- Established optimal forces are 2.9 kgf for infants (<10 kg, pediatric paddles) and 5.1 kgf for children (>10 kg, adult paddles).
Purpose of the Study:
- To compare actual defibrillation paddle forces used in simulated pediatric scenarios with established optimal values.
- To assess adherence to recommended paddle force guidelines during pediatric defibrillation simulations.
Main Methods:
- 72 healthcare professionals simulated pediatric defibrillation on infant and child manikins.
- Paddle force was measured during simulated shocks using pediatric and adult paddles.
- Applied forces were compared against known optimal values for different pediatric weight categories.
Main Results:
- Median force for infant manikins was 2.8 kgf, with only 47% of operators achieving optimal force.
- Median force for child manikins was 3.8 kgf, with only 24% of operators achieving optimal force.
- Significant variability in applied paddle force was observed, with some exceeding 10 kgf.
Conclusions:
- Paddle force applied during simulated pediatric defibrillation frequently falls below optimal levels.
- Inconsistent application of recommended paddle force may compromise defibrillation efficacy in pediatric patients.
Introduction:
Optimal paddle force minimises transthoracic impedance; a factor associated with increased defibrillation success. Optimal force for the defibrillation of children < or =10 kg using paediatric paddles has previously been shown to be 2.9 kgf, and for children >10 kg using adult paddles is 5.1 kgf. We compared defibrillation paddle force applied during simulated paediatric defibrillation with these optimal values.
Methods:
72 medical and nursing staff who would be expected to perform paediatric defibrillation were recruited from a University teaching hospital. Participants, blinded to the nature of the study, were asked to simulate defibrillation of an infant manikin (9 months of age) and a child manikin (6 years of age) using paediatric or adult paddles, respectively, according to guidelines. Paddle force (kgf) was measured at the time of simulated shock and compared with known optimal values.
Results:
Median paddle force applied to the infant manikin was 2.8 kgf (max 9.6, min 0.6), with only 47% operators attaining optimal force. Median paddle force applied to the child manikin was 3.8 kgf (max 10.2, min 1.0), with only 24% of operators attaining optimal force.
Conclusion:
Defibrillation paddle force applied during paediatric defibrillation often falls below optimal values.
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