Defibrillation and cardioversion in children (including automated external defibrillation)
- Richard J Scarfone, MD, FAAP
Richard J Scarfone, MD, FAAP
- Associate Professor of Pediatrics
- University of Pennsylvania School of Medicine
- Section Editor
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Defibrillation (DF) and cardioversion are methods of delivering electrical energy to the heart through the chest wall in an attempt to restore the heart's normal rhythm. Defibrillation and cardioversion may be accomplished using a manual defibrillator, which requires users to recognize the dysrhythmia and preselect the energy to be delivered. Alternatively, automated external defibrillators (AEDs) may be used. AEDs are computerized machines that automatically diagnose ventricular fibrillation (VF) and use voice prompts to instruct rescuers to defibrillate, if appropriate. In addition, based on preset values for heart rate and R-wave morphology, AEDs may advise defibrillation for ventricular tachycardia (VT).
This topic will review the technique of electrical countershock, including AED use, in children. The basic principles that underlie countershock treatment; the clinical indications for these procedures and the side effects that may be seen; and the development, use, allocation, and efficacy of automated external defibrillators (AEDs) are discussed separately. (See "Basic principles and technique of electrical cardioversion and defibrillation" and "Cardioversion for specific arrhythmias" and "Automated external defibrillators".)
There is an important distinction between defibrillation and cardioversion:
Defibrillation — Defibrillation is the asynchronous delivery of energy, such as the shock is delivered randomly during the cardiac cycle.
Cardioversion — Cardioversion is the delivery of energy that is synchronized to the QRS complex.
- Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 2004; 114:157.
- Young KD, Seidel JS. Pediatric cardiopulmonary resuscitation: a collective review. Ann Emerg Med 1999; 33:195.
- Martin DR, Gavin T, Bianco J, et al. Initial countershock in the treatment of asystole. Resuscitation 1993; 26:63.
- Smith BT, Rea TD, Eisenberg MS. Ventricular fibrillation in pediatric cardiac arrest. Acad Emerg Med 2006; 13:525.
- Mogayzel C, Quan L, Graves JR, et al. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med 1995; 25:484.
- Khoury A, Shavit I. Out-of-hospital ventricular fibrillation in three adolescents. Arch Dis Child 2009; 94:153.
- Deakin CD, Nolan JP, European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2005; 67 Suppl 1:S25.
- American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary and Emergency Cardiovascular Care - Part 12. Pediatric advanced life support. https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/ (Accessed on November 10, 2015).
- de Caen AR, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S526.
- American Heart Association. Part 3: Defibrillation. Circulation 2005; 112:III.
- Link MS, Atkins DL, Passman RS, et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S706.
- Hazinski MF, Nadkarni VM, Hickey RW, et al. Major changes in the 2005 AHA Guidelines for CPR and ECC: reaching the tipping point for change. Circulation 2005; 112:IV206.
- Hoke RS, Heinroth K, Trappe HJ, Werdan K. Is external defibrillation an electric threat for bystanders? Resuscitation 2009; 80:395.
- American Heart Association. Part 12: Pediatric advanced life support. Circulation 2005; 112:IV.
- Markenson D, Pyles L, Neish S, et al. Ventricular fibrillation and the use of automated external defibrillators on children. Pediatrics 2007; 120:e1368.
- Rossano JW, Quan L, Kenney MA, et al. Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation. Resuscitation 2006; 70:80.
- Meaney PA, Nadkarni VM, Atkins DL, et al. Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest. Pediatrics 2011; 127:e16.
- Rodríguez-Núñez A, López-Herce J, del Castillo J, et al. Shockable rhythms and defibrillation during in-hospital pediatric cardiac arrest. Resuscitation 2014; 85:387.
- Atkins DL, Berger S, Duff JP, et al. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S519.
- American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality. ECCguidelines.heart.org (Accessed on October 15, 2015).
- Berg MD, Schexnayder SM, Chameides L, et al. Pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2010; 126:e1345.
- Berg MD, Schexnayder SM, Chameides L, et al. Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S862.
- Kleinman ME, de Caen AR, Chameides L, et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261.
- Atkins DL, Kenney MA. Automated external defibrillators: safety and efficacy in children and adolescents. Pediatr Clin North Am 2004; 51:1443.
- International Liaison Committee on Resuscitation (ILCOR). Part 6: Pediatric basic and advanced life support. Circulation 2005; 112:III.
- Samson RA, Atkins DL. Tachyarrhythmias and defibrillation. Pediatr Clin North Am 2008; 55:887.
- American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, Markenson D. Ventricular fibrillation and the use of automated external defibrillators on children. Pediatrics 2007; 120:1159.
- ANATOMY AND PHYSIOLOGY
- Mechanism of action
- - Cardioversion
- - Defibrillation
- Shock delivery
- Coordination of shock delivery and chest compressions
- CONTRAINDICATIONS AND PRECAUTIONS
- Rescuer and bystander safety
- Patient counseling/informed consent
- Analgesia and sedation
- Methods: Manual defibrillator use
- - Electrode choice
- - Electrode size
- - Electrode placement
- - Electrode-chest interface
- - Machine operation
- Defibrillation dose
- Cardioversion dose
- Automated external defibrillator use in infants and children
- - Automated external defibrillator operation
- - Dose
- FOLLOW-UP CARE