AEDS AND INFANTS

[ibemt31]

Hey all... interesting issue i contemplated the other day and want to seek some feedback on. we were dispatched to an infant in cardiac arrest. the infant was not in cardiac arrest however, when we got there and the baby was fine. the point was that this got my thinking about infant arrests, not a relatively common call, thank goodness. i realized that i was never really taught definitively whether or not we use an AED on infant arrests (less than 1 y/o). i glance at the most current AHA CPR HCP confirms this. they state "currently there is not enough evidence to reccommend for or against the use of AEDs in infants less than one year of age". how are we as providers expected to have a definitive protocol to follow when the AHA does not even know the answer? do we or do we not AED infants? i do realize that the vast majority of infant arrests will not prevent in an AED shockable rythm and thus would be wasting valuable time, but for the infant that does happen to be in a shockable rythm the AED can make all the difference. i was just wondering what everyone else thought about this, and whether or not they would use an AED on an infant and what their rationale would be why or why not. it is scary that such a hole in the cpr protocols exists and the AHA should cover things better than that....i suppose ultimately it is a judgement call, but that is almost like flipping a coin with no reason to go on...heads AED tails NO AED. what do you all think?

-Lucas Simko-Bednarski

NREMT-B

[AMESEMT]

I am a CPR instructor (AHA guidelines) and we teach no AED for those under the age of 1 year. Also, the vast majority of arrest calls for infants are due to other reasons. Someone in one of my CPR classes asked the same thing and the paramedic there explained that typically infants do not have cardiac exclusive (i.e. heart attack) problems, but the cardiac aspect is brought on by something (i.e not breathing). Unless your protocols state something different, I would go by what the AHA Guidelines state.

[Scaramedic]

Kids are airway, airway, airway. Most pediatric/toddler/infant arrest are due to airway/breathing complications. A majority of adult arrests are cardiac involved hence the reason most AED's are programmed for adults. I can count the times on one hand I have had to defibrilate an infant.

[AMESEMT]

Were the infants under the age of 1?

[Scaramedic]

I remember one for sure was under one. I remember because we got him back only to get to hospital and see the cx x-ray to verify my tube placement. It looked like every rib in his chest was broken, to top that CT of his head showed a massive bleed.

Appearantly dad had held the baby in one hand and slammed him against the wall several times for crying.

So we got him back, only to be a carrot for a year before he died. That's why I remember that one.

[Dustdevil]

I remember one for sure was under one. I remember because we got him back only to get to hospital and see the cx x-ray to verify my tube placement. It looked like every rib in his chest was broken, to top that CT of his head showed a massive bleed.

I'm glad you went on to explain that.

For a moment, it was sounding like you used way too much energy! :shock:

[AZCEP]

Were the infants under the age of 1?

Going strictly by the AHA definition, all infants are <1 year old.

Most defib/AED pads are going to be too big to be placed on the infant without some overlapping of the conductive material anyway. The AED can be considered, as was already quoted, the AHA doesn't recommend for or against it's use in this situation.

Oh, and there are more and more congenital heart kids showing up all the time. While most will be respiratory/airway issues, the CHK's tend to be cardiac in origin and their families will be sure to tell you all about them.

[mobey]

We carry infant pads for both our AED and lifepak 12.

[Scaramedic]

I'm glad you went on to explain that.

For a moment, it was sounding like you used way too much energy! :shock:

I wish, he could have survived that, I'd be working at 7-11 but he would have lived. The way it was he died and his piece of sh*t father is probably out of prison by now.

[ARothenberg]

As stated above remember out terminology per AHA for ages

Infant <1 year old

Child 1yr - onset of puberty

Adult Puberty till death

As far as the AEDs on infants it is best to look back to your EMS system SOP/SMOs what your medical director wants. As the AHA stated there is no good data and most child cardiac arrests are due to airway isues or trauma.

Also remember that you have to make suere the pads are correct for the AED. Depending on the units you have they will either have a resistor in the peds pads to absorb the excess adult energy, or they will tell the AEDs programming to dial down the joules. Be cautions mixing pads from cardiac monitors/defibulators and AEDs, often they will fit on both, but the peds pads will not recuce the power setting since defibulators are designed to be manually set.

Adam

EMT-P, ACLS, PALS, PHTLS