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Published on: February 28, 2012
Prescribing an automated external defibrillator for children at increased risk of sudden arrhythmic death
Karen A McLeod1, Eileen Fern1, Fiona Clements1
1Departments of Cardiology and Clinical Genetics,Royal Hospital for Children,Queen Elizabeth University Hospitals,Glasgow,G51 4TF,United Kingdom.
Insights
Automated external defibrillators (AEDs) can save lives in out-of-hospital cardiac arrest. Parents can be trained to use AEDs for children at risk of sudden arrhythmic death, improving survival rates.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Emergency Medicine
Background:
- Automated external defibrillators (AEDs) are crucial for out-of-hospital cardiac arrest survival.
- Sudden arrhythmic death in children necessitates risk mitigation strategies.
- Pediatric cardiac electrophysiology services play a role in managing high-risk patients.
Purpose of the Study:
- To review the experience of prescribing automated external defibrillators (AEDs) to children at increased risk of sudden arrhythmic death.
- To evaluate the effectiveness and safety of AED use in pediatric patients.
- To assess the role of parental training in AED deployment.
Main Methods:
- Retrospective review of AEDs issued by the Scottish Paediatric Cardiac Electrophysiology Service (2005-2015).
- Analysis of patient demographics, diagnoses, and AED usage.
- Evaluation of resuscitation training provided to parents, including AED operation.
Main Results:
- 36 AEDs were issued to 36 families for 44 children; common diagnoses included long QT syndrome (50%).
- AEDs were used in 4 children (9%), correctly identifying shockable rhythms (ventricular fibrillation/polymorphic ventricular tachycardia) in 3 cases.
- Two of three children receiving shocks for ventricular fibrillation/polymorphic ventricular tachycardia survived; one died from recurrent torsades de pointes. No other deaths occurred.
Conclusions:
- Parents can be effectively trained in recognizing cardiac arrest, resuscitation skills, and AED use.
- Prescribing AEDs should be considered for pediatric patients at high risk of sudden arrhythmic death.
- AEDs offer a viable option when the risk/benefit of implantable defibrillators is uncertain or implantation is delayed.
Background:
Automated external defibrillators can be life-saving in out-of-hospital cardiac arrest.
Objective:
Our aim was to review our experience of prescribing automated external defibrillators for children at increased risk of sudden arrhythmic death.
Methods:
We reviewed all automated external defibrillators issued by the Scottish Paediatric Cardiac Electrophysiology Service from 2005 to 2015. All parents were given resuscitation training according to the Paediatric Resuscitation Guidelines, including the use of the automated external defibrillator.
Results:
A total of 36 automated external defibrillators were issued to 36 families for 44 children (27 male). The mean age at issue was 8.8 years. Diagnoses at issue included long QT syndrome (50%), broad complex tachycardia (14%), hypertrophic cardiomyopathy (11%), and catecholaminergic polymorphic ventricular tachycardia (9%). During the study period, the automated external defibrillator was used in four (9%) children, and in all four the automated external defibrillator correctly discriminated between a shockable rhythm - polymorphic ventricular tachycardia/ventricular fibrillation in three patients with one or more shocks delivered - and non-shockable rhythm - sinus rhythm in one patient. Of the three children, two of them who received one or more shocks for ventricular fibrillation/polymorphic ventricular tachycardia survived, but one died as a result of recurrent torsades de pointes. There were no other deaths.
Conclusion:
Parents can be taught to recognise cardiac arrest, apply resuscitation skills, and use an automated external defibrillator. Prescribing an automated external defibrillator should be considered for children at increased risk of sudden arrhythmic death, especially where the risk/benefit ratio of an implantable defibrillator is unclear or delay to defibrillator implantation is deemed necessary.
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