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 — Adult and Pediatric Emergency Medicine
- Senior 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.
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- 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