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Pediatric defibrillation: current flow is improved by using "adult" electrode paddles
1Department of Pediatrics, University of Iowa, Iowa City 52242.
Pediatrics
|July 1, 1994
Summary
Pediatric defibrillation and cardioversion are more effective with larger adult electrode paddles, which reduce transthoracic impedance and increase current flow. Using adult paddles, even on smaller children, improves outcomes by ensuring adequate current delivery.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Device Technology
Background:
- Defibrillation success is primarily determined by current flow, influenced by delivered energy and transthoracic impedance.
- Experimental data suggest higher transthoracic impedance with pediatric electrode paddles compared to adult ones, but clinical data are scarce.
Purpose of the Study:
- To measure transthoracic impedance during actual defibrillation/cardioversion shocks in pediatric patients.
- To determine the optimal electrode paddle size for effective pediatric defibrillation and cardioversion.
Main Methods:
- Prospective evaluation of pediatric shocks (<= 20 joules) at the University of Iowa (1988-1992).
- Collected data included energy settings, delivered energy, peak current, and transthoracic impedance.
- Analyzed data using unpaired t-tests and linear regression.
Main Results:
- Fifty-five shocks were delivered to 20 pediatric patients (newborn to 8 years).
- Transthoracic impedance was significantly higher with pediatric paddles (78.1 ohms) vs. adult paddles (54.6 ohms).
- Pediatric paddles resulted in lower peak current flow (6.2 amps) compared to adult paddles (8.7 amps).
Conclusions:
- Pediatric electrode paddles lead to increased transthoracic impedance and reduced peak current flow.
- Larger adult electrode paddles are recommended for pediatric defibrillation once chest size permits (approx. 10 kg).
- Lower transthoracic impedance achieved with adult paddles facilitates effective cardioversion and defibrillation.