Pad Size and Placement in Infants and Children

Insights

Electrophysiological factors that contribute to successful defibrillation include the delivery of sufficient current density throughout the myocardium. Automated external defibrillator pad placement and size are important factors to ensure that the current traverses the myocardium and is not shunted around the chest. Evidence from the adult population does not show a significant difference between an initial anteroposterior position compared with an anterolateral pad position for outcomes of defibrillation success, survival to hospital discharge and favorable neurological outcome at hospital discharge. However, there are no studies evaluating clinical outcomes with the use of any specific pad size, orientation or position in pediatric cardiac arrest with a shockable rhythm. Guideline recommendations in the pediatric population are therefore based on studies in adults, with downgrading of the certainty of evidence. In the United States, AED manufacturers typically provide device-specific packaging and voice prompts or pad placement diagrams. An anteroposterior pad placement recommendation is common for infants and children under 8 years or age, as this avoids overlap of AED pads on small chests. An anterolateral pad placement is used for adults and older children and may be faster to apply in this population. If pediatric pads are not available, adult pads can be used while avoiding overlap during positioning.