Defibrillator Use Urged to Save Children's Lives

MONDAY Oct. 29, 2007 -- The emergency defibrillators now commonly found in airports and other public places that have saved thousands of adult cardiac arrest victims can also save the lives of children.

That's the new position of the American Academy of Pediatrics (AAP), which is reminding its members -- and other physicians as well -- that the devices can safely be used on children younger than 8 years old.

"As AED [automated external defibrillator] programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for," said an AAP policy statement in the November issue of Pediatrics. The statement was released Monday during the American Academy of Pediatrics annual meeting in San Francisco.

Recent studies have shown that children do experience ventricular fibrillation, a potentially fatal condition in which the heart fails to contract properly. And, while the use of defibrillators to save a child's life by providing an electrical jolt has been advocated for several years, the "software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use on children," the statement said.

Dr. Steven E. Krug, chairman of the academy's committee on pediatric emergency medicine and a professor of pediatrics at Northwestern University Feinberg School of Medicine, said, the "overall incidence of ventricular fibrillation has been underestimated. It used to be thought that it was fairly uncommon in children. We now know that a fairly significant number of children have arrhythmias that need defibrillation."

The academy said the new report was being issued, because "there is a need for developing strategies to provide defibrillation to children younger than 8 years."

Fibrillation deaths "are rare events in children, but are moderately common in children who die cardiac deaths," particularly in school-age children, said Dr. Steven Neish, director of the pediatric fellowship program at Baylor University, who participated in preparing the policy statement.

"One area we worry about is young athletes who die of arrhythmias," Neish said. "The argument is about how common is common enough, and how cheap is cheap enough" to warrant the cost of a defibrillator, he said. With emergency defibrillators now commonly priced at about $1,000, "in comparison to other treatments, it makes a good case for defibrillators as preventive treatment."

Placing a defibrillator in a school also makes it available to school personnel and visitors, Neish pointed out.

"Also, at least as important is to more broadly teach people cardiopulmonary resuscitation," he said. "We have to make people comfortable with the procedure."

There are defibrillators designed specifically for use in children, Krug said, but concerns that adult defibrillators could damage children's hearts have disappeared.

"There has been an advance in the technology," Krug said. "Even in a situation where you can provide only an adult dose, that still may be better than doing nothing."

As with adults, defibrillation of children experiencing a problem must be done quickly, Krug said. "Time is of the essence," he said. "As time passes, the chance of resuscitation decreases rapidly."

The likelihood of survival decreases by 7 percent to 10 percent with each minute of delay to defibrillation after cardiac arrest, the AAP statement said.

The first recommendation contained in the academy's statement is that "strategies and equipment availability for treatment of pediatric arrest should be focused on shortening the intervals from collapse to recognition of ventricular fibrillation and to defibrillation."

Another recommendation is that any community public-access defibrillation program use devices capable of treating children. And any program to place defibrillators in schools should include staff training in basic first-aid and resuscitation and should be integrated with the local emergency medical system, the academy recommended.

Posted: October 2007


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