Is a Manual Defibrillator Preferred for Infants When Available?

When it comes to saving lives, every second counts, especially in infant cardiac emergencies. As with adults, defibrillators play a crucial role in restoring normal heart rhythms in infants. However, infant cardiac emergencies present unique challenges that require a different approach. This article sheds light on the key differences between manual and automated external defibrillators, the intricacies of infant physiology, and the importance of proper training and equipment access for healthcare professionals and emergency responders. Additionally, we will discuss why “a manual defibrillator is preferred for infants when available” and the benefits it offers in these critical situations.

Sudden Cardiac Arrest

Sudden cardiac arrest (SCA) is a medical emergency characterized by the sudden loss of heart function, breathing, and consciousness, generally due to an electrical disturbance in the heart that halts its pumping capability and cuts off blood flow to the rest of the body. Addressing the critical query of when is a defibrillator used?: it is at this crucial juncture that the immediate application of a defibrillator is paramount. This device is specifically designed to deliver a therapeutic dose of electric current to the heart, with the intent of re-establishing a normal rhythm. Automated External Defibrillators (AEDs) are strategically placed in easily accessible public locations for prompt use by individuals, even those with minimal training, during an SCA episode. The time frame for using a defibrillator is as soon as possible after the onset of SCA, preferably within the first few minutes to maximize the chances of survival, with each minute’s delay dramatically reducing the probability of a positive outcome.

Manual vs. Automated External Defibrillators for Infants

Manual and automated external defibrillators (AEDs) serve the same purpose: to deliver an electric shock to the heart in an attempt to restore normal rhythm. However, when it comes to infants, these devices have notable differences in their functionality. Manual defibrillators allow trained healthcare professionals to manually analyze the heart rhythm and determine the appropriate energy level for defibrillation, while AEDs are automated and designed for use by laypersons. Although AEDs are the most frequently employed devices in pediatric emergencies, manual defibrillators remain the preferred choice for infant cardiac emergencies due to their adjustable energy levels and manual control.

As AEDs become increasingly accessible and user-friendly, their prevalence in public spaces has grown. Despite their benefits, AEDs have limitations when it comes to treating infant cardiac arrests, such as the inability to deliver the recommended initial shock dose for infants in ventricular fibrillation (VF) and lower specificity for non-shockable rhythms. Gaining insights into the key features of both manual and automated defibrillators aids in making informed decisions during infant cardiac emergencies.

Key features of manual defibrillators

Manual defibrillators are versatile devices capable of delivering life-saving shocks to the heart, as well as offering multiple modes of operation like synchronized cardioversion and internal defibrillation. A crucial aspect of manual defibrillators is their ability to provide customizable energy delivery, allowing healthcare professionals to manually set the energy level of the shock delivered to the patient. This customization ensures that the treatment is tailored to the specific needs of the infant, enhancing the chances of successful defibrillation.

Another significant feature of manual defibrillators is rhythm monitoring. After 2 minutes of high-quality CPR, healthcare professionals can assess the electrical rhythm of the patient’s heart on the monitor following the initial defibrillation. Identifying any dysrhythmias and deciding on the appropriate treatment course for the infant is possible due to this monitoring capability.

Key features of automated external defibrillators

Automated external defibrillators are renowned for their ease of use and accessibility, making them a popular choice for first-response Emergency Medical Services (EMS) personnel. AEDs automatically analyze the heart rhythm and deliver a shock if necessary, without the need for manual intervention. However, there are limitations to AEDs in infant cardiac emergencies, such as their inability to deliver the recommended initial shock dose for infants in VF and lower specificity for non-shockable rhythms.

Pediatric one-pad/cable systems are designed for use with AEDs. This helps reduce the pediatric dose of energy delivered to patients under 8 years of age to an amount between 50 and 75 joules. Despite being a successful and safe option for infant resuscitation, AEDs are typically limited to delivering lower energy shocks compared to manual defibrillators, which can be operated by trained medical professionals to deliver higher energy shocks tailored to the infant’s needs.

Infant Cardiac Arrest: Unique Considerations

Infant cardiac arrest presents distinctive challenges compared to adult cases, primarily due to differences in respiratory and cardiovascular physiology. Infants can experience pulseless arrest as a result of asystole, and their cardiac arrests are generally not caused by primary cardiac issues. Furthermore, the recommended energy levels for defibrillating infants differ from those for adults, usually being lower. To ensure the appropriate treatment and the best possible outcome for the infant, these unique considerations must be recognized.

The prevalence of ventricular fibrillation (VF) as the initial rhythm in pediatric cardiac arrest, excluding sudden infant death syndrome (SIDS) deaths, is reported to be 19% to 24%. With such a significant percentage of pediatric cardiac arrests involving VF, it’s vital for healthcare professionals and emergency responders to understand the specific factors that influence the success of defibrillation in infants.

Differences in infant physiology

The unique physiological characteristics of infants, such as their smaller chests, and disparities in musculature, bone density, and strength compared to adults, can impact the effectiveness of CPR and the delivery of adequate current flow during defibrillation. Furthermore, infants may have normal variations in heart rate and rhythm, such as respiratory sinus arrhythmia, which are considered normal in children and young adults.

The size and structure of an infant’s heart can also influence defibrillation procedures. Research has shown that the size of the paddle or pad used for defibrillation can alter transthoracic impedance, which may affect the efficacy of defibrillation. Additionally, the optimal placement of implantable cardioverter-defibrillators (ICDs) in infants is not reliably predictable, further emphasizing the need for a tailored approach in infant cardiac emergencies.

Pediatric pads and energy levels

Using pediatric pads and lower energy levels is crucial for infant defibrillation. Biphasic waveforms allow for a lower energy dose during defibrillation. This helps to reduce the risk of myocardial damage to pediatric hearts. The American Heart Association (AHA) recommends energy levels of 2 J/kg for defibrillating infants, escalating to 4 J/kg. Keep in mind that the exact energy levels may vary depending on the specific defibrillator used.

The administration of defibrillation to infants using inappropriate energy levels can have potential consequences, such as:

• Increased risk of injury

• Overstimulation

• Disruption of sleep patterns

• Potential long-term effects on development

Therefore, it is crucial to use the correct energy levels and equipment specifically designed for infants to ensure the efficacy and safety of defibrillation.

The Preference for Manual Defibrillators in Infant Treatment

In infant cardiac emergencies, manual defibrillators are generally favored because of their adjustable energy delivery and rhythm monitoring capabilities. The ability to customize the energy delivered to the infant ensures that the treatment is tailored to their specific needs, enhancing the chances of successful defibrillation and improving survival rates.

Moreover, manual defibrillators may feature rhythm monitoring capabilities to detect dysrhythmia and preselect the energy to deliver the shock, as well as pacing capabilities to stimulate heart contraction. These features make manual defibrillators the ideal choice in infant cardiac emergencies, ensuring the safety and efficacy of the treatment.

Customizable energy delivery

The ability to deliver precise energy levels tailored to an infant’s needs is a crucial advantage of manual defibrillators. Healthcare professionals can manually set the energy level of the shock delivered to the patient, ensuring that the energy is suitable for the infant’s size and condition. This customization enhances the chances of a successful defibrillation and improves survival rates.

The range of energy levels that can be delivered by a manual defibrillator typically varies between 120 joules and 200 joules. The American Heart Association recommends a dose of 2 J/kg for infant resuscitation using a manual defibrillator, although recent reports suggest that higher dosages may be more effective and safe. Following the guidelines and recommendations provided by medical professionals and organizations is crucial.

Rhythm monitoring and decision-making

In managing infant cardiac emergencies, rhythm monitoring plays a vital role by enabling healthcare providers to assess the newborn’s heart rate and rhythm and guide appropriate treatment. Manual defibrillators enable healthcare professionals to continually observe the patient’s cardiac activity, identifying any abnormal heart rhythms or arrhythmias.

This monitoring capability is particularly important for infants, as their developing cardiovascular system and unique heart rhythms present challenges that require a tailored approach. By closely monitoring the infant’s heart rhythm, healthcare professionals can make informed decisions on the appropriate treatment course, ensuring the best possible outcome in these critical situations.

When to Use an Automated External Defibrillator on Infants

While manual defibrillators are the preferred choice for treating infant cardiac emergencies, there are situations where an automated external defibrillator (AED) may be used on infants. For instance, when a manual defibrillator is unavailable or in cases involving children aged 1-8 years. Recognizing the limitations of AEDs in infant cardiac emergencies is critical and they must be used with caution, ensuring the use of pediatric pads and appropriate energy levels.

The current recommendations for AED use on children state that:

• AEDs should be employed for rhythm identification in children aged 8 and above

• Attempted defibrillation may be considered for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in these older children

• AEDs are not advised for infants under 1 year old due to a lack of evidence supporting their use in this age group.

Lack of manual defibrillator availability

Manual defibrillators are not generally available in public places, with automated external defibrillators (AEDs) being the devices typically found in public locations for public access defibrillation. In the absence of a manual defibrillator, AEDs can be employed on infants suspected of suffering from cardiac arrest, provided that an AED with a dose attenuator or pediatric pads is used.

Although potential risks may be associated with using an AED instead of a manual defibrillator on infants, these risks are generally rare. Available evidence indicates that AEDs can correctly identify pediatric arrhythmias and are deemed safe for use in infants. The key is to use pediatric-specific pads and settings on the AED to ensure appropriate energy levels for children.

Age considerations

AEDs are not recommended for infants under 1 year old due to a lack of evidence supporting their use in this age group. However, they can be used with caution for children aged 1-8 years, as their more developed anatomy and physiology allow for better response to defibrillation. The stronger cardiovascular system and muscle mass of children in this age group increase the chances of successful defibrillation. Still, it is important to use pediatric-specific pads and settings on the AED to ensure appropriate energy levels for children.

The potential risks associated with using AEDs on children aged 1-8 years include the risk of delivering an energy level that may be too high for a child’s smaller body, which could potentially cause harm. By using AEDs with pediatric-specific settings or child pads, healthcare professionals can reduce this risk and provide effective defibrillation treatment for young children.

Training and Preparedness for Infant Cardiac Emergencies

Healthcare professionals and emergency responders must have proper training and access to appropriate equipment to competently respond to infant cardiac emergencies. This includes specialized pediatric automated external defibrillator (AED) training, which adheres to the guidelines established by organizations such as the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR).

Providing adequate training and equipment access ensures that medical professionals and emergency responders can effectively handle infant cardiac emergencies, improving survival rates and reducing the risk of long-term complications. Regular refresher training is also crucial for maintaining skill levels and staying up-to-date with the latest guidelines and recommendations.

CPR and defibrillator training

Specialized pediatric AED training encompasses the proper use of AEDs on infants and children, including the use of pediatric AED pads and the appropriate energy levels for defibrillation. Certified training in pediatric CPR and AED usage is recommended for individuals who may be required to use an AED on infants.

Healthcare professionals should receive refresher training on infant CPR and defibrillator use at least every 3 to 6 months to prevent skill deterioration. To ensure the safety and efficacy of defibrillation in infants, it is important to adhere to the guidelines and recommendations provided by medical professionals and organizations, such as the American Heart Association.

Access to appropriate equipment

For effective infant cardiac emergency response, it is crucial to have both manual defibrillators and AEDs with pediatric pads and energy levels readily available in emergency situations. In contrast, adult pads are designed for use on older patients. The most commonly available types of defibrillators in emergency settings are automated external defibrillators (AEDs) and advanced life support defibrillators. Ensuring compatibility with the defibrillator, appropriate size and positioning of the pads, and the capability to adjust energy levels for infant safety is essential when procuring pediatric pads for infant defibrillation.

The cost of a new automated external defibrillator (AED) can range from $1,200 to $3,000. While cost is a consideration, the importance of having access to the appropriate equipment in emergency situations cannot be overstated. Adequate equipment access plays a vital role in improving survival rates and reducing the risk of long-term complications in infant cardiac emergencies.

Summary

In conclusion, treating infant cardiac emergencies requires a unique approach, taking into consideration the distinct physiological characteristics of infants, the differences between manual and automated external defibrillators, and the necessity for proper training and equipment access. By understanding these factors and adhering to the guidelines and recommendations provided by medical professionals and organizations, healthcare professionals and emergency responders can improve survival rates and outcomes for infants experiencing cardiac emergencies.

Frequently Asked Questions

Is a manual defibrillator preferred to an AED for infants?

For infants, the preferred option is always a manual defibrillator that is able to set considerably lower energy levels. If a manual defibrillator is not available, an AED with a dose attenuator may be used, but pediatric pads should always be purchased separately unless your AED has combination adult and pediatric pads.

Can defibrillators be used on babies?

Yes, defibrillators can be used on babies, and it is advised to use them as soon as possible for the best chance of survival. Pediatric pads should be used if the person is less than eight years old or less than 55 pounds (25 kg).

What is recommended for the AED regarding infants and children?

For infants and children, the American Heart Association recommends using pediatric electrode pads for those under eight years old, while adult pads are suitable for those aged eight and above.