Inappropriate Shocks and Power Delivery Using Adult Automatic External Defibrillator Pads in a Pediatric Patient

Abstract

The use of automatic external defibrillators (AEDs) during pulseless resuscitations is considered safe and reliable, and was established as part of the guidelines in out-of-hospital events. Based on extensive studies, the use of the standard AED is now indicated in every age group with a preference of pediatric pad application for small children and babies. If unavailable, adult pads are recommended. We report a case of 2 inappropriate AED shocks that were delivered to a neonate during a pulseless resuscitation after application of adult pads. The 3.6-kg patient received 2 shocks, over 200 J each, for sinus bradycardia that was not detected by the device. Although treated inappropriately with high voltage, no cardiac or skin sequelae were detected, and the patient had normal cardiac and neurological development later on.

Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period—A Systematic Review

“…In summary, 113 neonates, who received an electric countershock due to arrhythmias, were reported. Of these, only two neonates (1.8%) were shocked in an outpatient setting [ 11 , 12 ].…”

“…Thirty-four articles (87.2%) [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] stated the patients’ gestational ages. The described neonates ranged from 25 +2 to 40 +4 weeks of gestation.…”

“…One case [ 13 ] reported electric CV in an extremely preterm infant (25 +2 weeks of gestation), and another study [ 14 ] in a very preterm infant (28 +0 weeks of gestation). In twenty-five articles (64.1%) [ 7 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 31 , 35 , 36 , 37 , 38 , 41 , 42 , 43 , 44 , 45 ] including sixty-one patients (54%), the patients’ sex was described. In these articles, females ( n = 29, 47.5%) and males ( n = 32, 52.5%) were equally affected by arrhythmias.…”

Automated external defibrillator use in a previously healthy 31‐day‐old infant with out‐of‐hospital cardiac arrest due to ventricular fibrillation

“…In the current case, our patient received two 50 J shocks (nearly 12 J/kg) without apparent cardiac dysfunction. Inappropriate shocks from an AED using adult pads on a 2‐week‐old 3.6 kg child have been reported . Although that child received a 222 J shock followed by a 218 J shock, there were no skin burns and only mildly reduced cardiac function which normalized after 2 days.…”

“…Inappropriate shocks from an AED using adult pads on a 2-week-old 3.6 kg child have been reported. 9 Although that child received a 222 J shock followed by a 218 J shock, there were no skin burns and only mildly reduced cardiac function which normalized after 2 days. In all reported infant AED cases, the patients survived to hospital discharge.…”