Paediatric Biphasic Recommendations
Paediatric Defibrillation - Current Guidelines
The 2010 AHA Guidelines state that, "based on data from adult studies and paediatric animal models, biphasic shocks appear to be at least as effective as monophasic shocks and less harmful. With a manual defibrillator (monophasic or biphasic), use a dose of 2 J/kg for the first attempt and 4 J/kg for subsequent attempts."
ZOLL Biphasic Approval for Paediatrics
FDA approval for the use of ZOLL's Rectilinear Biphasic™ waveform technology on paediatrics was based on the results from A Comparative Biphasic Defibrillation Study for Pediatric Dosing Levels Using a Porcine Model. This study demonstrates the safety and efficacy of this waveform on paediatric patients, and supports a defibrillation protocol of 2J/kg. Although this is the same protocol as used with monophasic waveforms, paediatric patients will benefit from a reduced possibility of myocardial dysfunction associated with the use of biphasic waveforms, which deliver less peak current than monophasic waveforms.
Use of ZOLL AEDs for Paediatric Defibrillation
The ZOLL AED Plus® defibrillator and the ZOLL AED Pro® have been approved for defibrillation of paediatric patients with the use of ZOLL's AED Plus pedi-padz® II . Sudden cardiac arrest rarely strikes a small child. When it does, the American Heart Association recommends the use of an AED that delivers lower, paediatric doses of energy. [1]
The AED Plus and AED Pro defibrillators provide several advantages over other AEDs for paediatric defibrillation. First, they let you know which kind of rescue is in progress: adult or paediatric. This helps prevent mistakes. Rescuers are less likely to deliver too little energy to an adult because paediatric pads are attached, or too much energy to a child because adult pads are attached. Rescuers can even switch pads in mid-rescue if they discover a mistake.
Second, unlike most other AEDs, with paediatric pads attached, the AED Plus and AED Pro use an ECG rhythm analysis that has been specifically designed and tested with ECGs specific to the paediatric patient population, particularly rhythms such as ventricular and supraventricular tachycardias that are very different from adults. [2]
Finally, these devices also deliver specific lower energy levels for children. Default energy settings for paediatric defibrillation with the AED Plus and AED Pro are 50 J, 70 J, and 85 J. Energy settings can be configured by the customer with the use of ZOLL Administrative Software. Other AEDs send higher adult levels of energy to their paediatric pads, and then count on special resistors in the wires to reduce the energy delivered to the child's heart. Added resistors will often result in waveform durations that are too long, thus potentially reducing the effectiveness of the waveform. The AED Plus and AED Pro always deliver the lower energy levels specific to a paediatric rescue with the optimal duration and current levels. Your rescuers can rest assured the energy delivered will be right for the child they are rescuing.
Read on to uncover the unique advantages of ZOLL's Rectilinear Biphasic waveform:
Principles of Electricity
More Current at 200 J than other biphasic waveforms at 360 J
Optimal Duration for Defibrillation Shocks
Superior for Cardioversion of Atrial Fibrillation
Superior for Defibrillation of Ventricular Fibrillation
Superior for Defibrillation of Out-of-Hospital Cardiac Arrest
Paediatric Biphasic Recommendations
Bibliography
[1] Sampson RA, Berg RA, Bingham R et al. Use of automated External Defibrillators for Children: An Update. Circulation 2003: 107:3250-3255
[2] Atkins D, Law I, Blaufox A et al. Automated external defibrillator analysis specifically designed for pediatric patients. Journal of the American College of Cardiology. 2005:1090-228. Abstract.