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AED Use on Infants and Children

Can you use an adult AED on an infant or small child?

In a word, YES! Although AEDs are manufactured with adults in mind, pediatric settings and pads adjust the energy level used, making them safe for young children who weigh less than 55 pounds. The American Heart Association recommends that pediatric attenuated pads should be used on children under the age of eight and on infants. Adult pads are used on children eight years and older.

However, the Journal of Pediatric Emergency Care notes that “In the absence of prompt defibrillation for ventricular fibrillation or pulseless ventricular tachycardia, survival is unlikely. Automated external defibrillators should be used in infants with suspected cardiac arrest, if a manual defibrillator with a trained rescuer is not immediately available. Automated external defibrillators that attenuate the energy dose (eg, via application of pediatric pads) are recommended for infants. If an AED with pediatric pads is not available, the AED with adult pads should be used.”

We think this bears repeating: if infant or pediatric settings and pads are not available, rescuers may use adult pads on infants and young children. Apply one pad to the front of the chest and the other to the child’s back so that the pads do not come into contact with one another.

Once the pads are attached, follow the instructions given by the AED.

Remember, without prompt treatment (CPR and defibrillation), sudden cardiac arrest (SCA) is always fatal. If you have an AED and you suspect that a child or infant is in cardiac arrest, use it!

All AEDs are designed to analyze a victim’s heart rhythm regardless of age, and if a shockable rhythm is detected, the device will prompt the rescuer to administer an electric shock. Some devices will administer shocks automatically. An AED will not advise or deliver a shock unless the victim’s heart rhythm is in one of two shockable rhythms. You cannot accidentally shock someone with an AED.

How Do You Recognize Pediatric AED Pads?

Pediatric electrode pads are typically smaller and feature a different color packaging than adult pads. Generally speaking, the instructions and pad placement illustrations will depict a small child or infant. If your AED requires a child/infant key, the key will likely have an illustration on it showing the proper placement of the adult AED electrode pads for use on a child or infant.

How Common is Sudden Cardiac Arrest in Children?

Thankfully, SCA is fairly uncommon in children. According to the Children’s Hospital of Philadelphia, “Although SCA is rare in children, it can affect anyone, even those who are physically fit. Each year, SCA claims the lives of over 2,000 children and adolescents in the U.S. and accounts for approximately 3-5% of all deaths in children aged 5-19 years. It is also responsible for 10-15 percent of sudden unexpected infant deaths.”

The 2015 AHA Heart and Stroke Statistics released by the American Heart Association found that 6,300 Americans under the age of 18 experienced an EMS-assessed out-of-hospital cardiac arrest (OHCA). When CPR and AEDs are administered within three to five minutes of cardiac arrest, sudden death can be prevented.

What Causes Sudden Cardiac Arrest in Young People?

Some of the most common causes of sudden cardiac death in young people include:

Hypertrophic Cardiomyopathy (HCM)

A condition that’s typically inherited, HCM causes the heart muscle cells to enlarge, which then causes the walls of the ventricle (usually the left ventricle) to thicken.

Congenital Abnormalities

Occasionally people are born with unusual or abnormal heart arteries. If this occurs, arteries may become compressed during exercise and not provide adequate blood flow to the heart. Some congenital cardiac abnormalities include Long QT syndrome, atrial septal defects, ventricular septal defects, and Ebstein anomaly.

Commotio Cordis

Commotio cordis is a rare cause of sudden cardiac death that occurs as the result of a blunt blow to the chest. Young athletes are especially susceptible and the average age of athletes who suffer from sudden cardiac arrest is just 17.

How is Infant and Child CPR different than Adult CPR?

Child and infant CPR is different from adult CPR. We strongly urge you to take an AHA-approved CPR and AED certification class. These classes will teach you how to perform adult, child, and infant CPR and how to effectively use an AED.

CPR for children is very similar to adult CPR, however, rescuers should start CPR before calling 911. After two minutes of CPR with rescue breaths, call 911. Because a child’s airway is more fragile than an adult’s, use caution when providing rescue breaths and be careful not to tilt the head back too far. When providing chest compressions, use one or two hands, depending on the size of the child. The depth of compressions should be only one and a half inches. The ratio of compressions to rescue breaths, 30:2, is the same for children as for adults.

It stands to reason that great care should be taken when performing CPR on an infant. Although a baby’s bones are more flexible than an adult’s, they’re also much more delicate. As with older children, you’ll want to begin CPR on an infant before calling 911. Of course, if there’s another person at the scene, ask them to call 911 immediately.

To learn more about our CPR and AED Training or to purchase an AED with pediatric capabilities, visit aed.com or call Cardio Partners at 866-349-4362. You can also email us at customerservice@cardiopartners.com.

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What You Need to Know About Agonal Breathing

What are Agonal Respirations or “Last Gasps”?

Gasping, or agonal respiration, is an indicator of cardiac arrest. When these irregular breathing patterns occur, it’s a sign that the victim’s brain is still alive and that you must begin uninterrupted chest compressions or CPR immediately.

If you do so, the person as a much higher chance of surviving. In fact, bystander-initiated CPR has been proven to be a sudden cardiac arrest (SCA) victim’s best chance of survival. Approximately About 90 percent of people who experience an out-of-hospital cardiac arrest (OHCA) die; however, nearly 45 percent of OHCA victims survived when bystander CPR was administered (American Heart Association).

Often, agonal breathing is seen during cardiac arrest, and in most cases rescuers report observing these so-called “dying breaths” fewer than 10 to 12 times per minute (as opposed to 12-20 inhalations in typical respiration).

Agonal respiration does not provide adequate oxygen to maintain body functions and should not be considered breathing.

Gasping or agonal respirations commonly occur following or during sudden cardiac arrest or stroke. Based on paramedic reports, researchers found that gasping occurred in 56% of patients who suffered an out-of-hospital cardiac arrest. They also found that gasping or agonal breathing is likely more common soon after cardiac arrest and is most common in individuals who receive bystander CPR (Science Direct).

Symptoms of Agonal Breaths

Agonal breathing can last for minutes or up to several hours. Someone who is suffering from agonal breathing may appear to be gasping for air, snorting, gurgling, or moaning, or they may make grunting sounds or display myoclonus — the sudden, uncontrollable jerking of muscle groups.

“The gasping associated with agonal breathing is not true breathing, but rather a brainstem reflex. Agonal breathing often occurs because the heart is no longer circulating oxygen-rich blood. In other cases, it may be due to the lungs not bringing in enough oxygen” (Medical News Today).

Causes of Agonal Breathing

In most cases, patients that suddenly stop breathing without warning and exhibit agonal breaths are likely suffering from cardiac arrest. However, respiratory arrest brought on by severe asthma, choking, stroke, or an opioid or narcotic overdose may also cause agonal breathing.

How to Treat Agonal Breathing

If someone is exhibiting symptoms of agonal breathing, resuscitation efforts should begin immediately and 911 should be called.

“In cases where the patient is not breathing or has agonal respirations but still has a pulse, he or she is considered to be in respiratory arrest rather than cardiac arrest. The 2015 CPR guidelines call for lay rescuers to treat both conditions the same: by starting CPR” (Very Well Health).

The Value of Gasping During Out-of-Hospital Out-of-Hospital Cardiac Arrest

In 2017 a study published in the Journal of the American College of Cardiology found that gasping during CPR was associated with an increased survival rate. The study noted that “These findings underscore the importance of not terminating resuscitation prematurely in gasping patients and the need to routinely recognize, monitor, and record data on gasping in all future cardiac arrest trials and registries.”

What You Can Do to Help Someone Suffering from Agonal Breathing

Learn CPR. Without CPR, agonal breathing brought on by cardiac arrest is fatal. If you know someone who is at an increased risk for a stroke or cardiac arrest, you’ll need to be able to quickly identify the symptoms and then respond with high-quality CPR.

Ready to learn CPR? As an Authorized Training Center, Cardio Partners provides high quality and consistent CPR and AED training courses across the United States. Our courses are offered through the American Red Cross and the American Heart Association. For more information about blended or traditional CPR and First Aid training, call our team at 866-349-4362 or email us at customerservice@cardiopartners.com.

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Be Ready to Help in a Heartbeat

Student athletes spend hours training for competition — but how about training to save a life?

SCA on soccer field.

Studies show that 6,000 – 8,000 teens experience sudden cardiac arrest (SCA) annually.1 Every three days, a student athlete falls victim to sudden cardiac death.2

Student athletes are at heightened risk for SCA due to the additional strain placed on the heart during athletic conditioning and competition. Contributing factors include the influx of adrenaline, dehydration, fever, and changes in electrolytes.3

While SCA isn’t preventable, sudden cardiac death can be. All it takes is to educate students on the symptoms that can precede an SCA event and to have an automated external defibrillator (AED) readily available during athletic practices and competition.

SCA can strike without warning, but sometimes symptoms are presented. Student athletes often dismiss symptoms preceding an SCA event for fear of losing precious game time. That’s why it’s vitally important for athletes to fully understand the risks they face and feel confident speaking up to prevent sudden cardiac death.

Here are some of the warning signs:5

  • Fainting
  • Chest pain
  • Shortness of breath
  • Irregular heartbeat – racing or fluttering
  • Dizziness or lightheadedness
  • Extreme fatigue

Nine out of ten victims who receive a shock from an AED within the first minute of SCA survive.4 Ensuring that your students and coaches are trained to respond to an SCA emergency could help save a life.

Download the ‘Help in a Heartbeat’ flyer to educate your team about the symptoms of SCA.

To learn more about the latest package from Cardiopartners to help your athletic teams respond to any emergency, visit: https://www.aed.com/zoll-aed-plus-athletic-director-s-package

1 “Sudden Cardiac Arrest and Teenage Athletes: What’s the Risk?”. Promise powered by Nemours Children’s Health System. https://blog.nemours.org/2017/02/sudden-cardiac-arrest-teenage-athletes-risk/

2 “Young Athletes & Sudden Cardiac Arrest”. Boston Scientific. http://www.your-heart-health.com/content/close-the-gap/en-US/heart-disease-facts/young-athletes.html

3 “Sports and Sudden Cardiac Arrest(SCA)”. Cardiosmart – American College of Cardiology. https://www.cardiosmart.org/Heart-Conditions/Sports-and-Sudden-Cardiac-Arrest

4Source: 2017, AHA Mediagenic Survey Results; 2017, AHA with Edelman Intelligence; 2017, AHA with BLR Media; Postgrad Medical Journal, October 2007.

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