Abstract 105: Evaluation of a New, Lower Dose for Pediatric Defibrillation with Automated External Defibrillators
Introduction The new AHA Guidelines recommend a pediatric AED dose for pediatric VF, yet the optimal pediatric dose remains unknown. We have previous reported that biphasic escalating doses of 50–75– 86J were effective at terminating VF, resulted in less post-resuscitation myocardial dysfunction, and produced better outcomes than defibrillation with biphasic adult shocks (200–300–360 J). We hypothesized that a 35 J pediatric shock dose (lower, non-escalating) would be safe and effective in the same piglet model of prolonged VF compared with adult doses.
Methods Following 7 minutes of untreated VF, 24 piglets were randomized to receive either biphasic shocks at 35–35–35 J (Bi35 group) or 50–75– 86 J (Bi50 group) via pediatric-sized pads or adult shocks at 200–300–360 J (Bi200 group) via adult pads. Resuscitation was per pediatric BLS protocol to 20 minutes, then pediatric ALS protocol to 27 minutes. A nonparametric statistical test (Kruskal-Wallis with Dunn correction) was used.
Results Piglets (19±3kg) required more Bi35 than Bi200 shocks to terminate the initial VF episode (*p=0.03) and received more shocks overall (7.9±6.3 vs 1.4±0.5, p=0.008). There was no significant difference between the 3 groups in cumulative dose. Animals defibrillated with 35 J had a 10% decrease in LVEF from baseline at 4 hours versus a 32% decrease in piglets receiving the adult dose shock (p=0.14). Survival to 4 hours was nearly equal between the three groups with good neurological outcome in 7/8 Bi35 piglets versus 3/8 Bi200 (p=0.09).
Conclusion Outcomes were similar for this lower dose and the previously proven 50 J pediatric AED dose. Compared to the adult dose, both attenuated doses tended to be associated with less myocardial dysfunction and better 24-hour outcome. Although this lowest dose required more shocks than the adult dose, our results suggest that this new, lower dose would be safe and effective for pediatric defibrillation.