Use of Automated External Defibrillators in Pediatric Population Remains Low, Study Finds

By Peter Aziz, MD

The emotional burden exacted by sudden cardiac death in the young weighs not only on the grieving family members, but also on the community at large. These tragic cases are fortunately rare, and predicting those young patients that are at risk for sudden death is difficult. Survival rates for pediatric-out-of-hospital cardiac arrests (OHCA) is dismal at less than 10%, with no significant improvement in the recent past.1

The use of AEDs improves survival in pediatric patients suffering from cardiac arrest. 2 For this reason, AED use is recommended by the American Heart Association (AHA) guidelines in all pediatric victims of a sudden cardiac arrest.3 However, the use of AEDs in the pediatric population remains low and likely contributes to poor outcomes in young victims, according to a study published in Pediatrics.

Age is most powerful predictor of AED application

Using prospectively collected data from the Cardiac Arrest Registry to Enhance Survival (CARES),4 we identified 1,398 pediatric patients ( 1 – 18 years of age) with OHCA.5 AEDs were applied to only 28% of these patients prior to the arrival of emergency medical services (EMS). Looking at patient characteristics in detail, we found that the age of the child was the most powerful predictor of AED application, regardless of race, sex, location or neighborhood characteristics. Older patients (12 – 18 years of age) were 1.4 times more likely to have AEDs applied than younger patients (2 – 11 years of age). As predicted, patients with witnessed cardiac arrests in public venues were more likely to have AEDs applied prior to the arrival of EMS.

Awareness campaigns needed

This is the largest study to examine the presence of disparities in AED application by first responders in the pediatric population. The low AED application rate of 28% is likely multi-factorial. One factor is that arrests in the pediatric age group are often assumed to be respiratory. AEDs, therefore, are not considered useful. This is certainly at odds with AHA recommendations. Although the medical community and pediatric providers are aware that AEDs are “safe” to use in the pediatric patient, many responders fear causing harm by using “adult” devices on smaller patients. Hopefully this study and others will highlight the importance of early and universal AED use in pediatric patients, and this awareness may provide momentum to flatten these obstacles.

1. Young KD, Gausche-Hill M, McClung CD, et al. A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics. 2004;114(1):157-64.
2. Smith BT, Rea TD, Eisenberg MS. Ventricular Fibrillation in Pediatric Cardiac Arrest. Acad Emerg Med. 2006;13(5):525-529.
3. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S876-S908.
4. Chan PS, McNally B, Tang F, Kellermann A, CARES Surveilliance Group. Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation. 2014;130(21):1876-82.
5. El-Assad I, Al-Kindi SG, McNallly B, et al. Automated External Defibrillator Application Before EMS Arrival in Pediatric Cardiac Arrests. Pediatrics. 2018;142(4):e20171903.