Version June 2024
| • Precise coordination between CPR and defibrillation is essential to minimize the time between a chest compression and shock delivery as well as the time to resume compressions immediately after a shock. |
| • Electrode pads offer several advantages over electrode paddles: |
| - Designed to monitor the heart rhythm without the need for additional electrocardiogram electrodes that may interfere with pad placement |
| - No need for application of creams or gels; arcing of electrical current is less likely |
| - Not associated with sparks that may ignite fires |
| - A rescuer is less likely to contact the patient's stretcher during shock delivery |
| - Application of improper paddle pressure is eliminated as a possible reason for failure of defibrillation |
| • Paddles and electrode pads designed for adults should be used for children who weigh more than 10 kg. Of these, those 12 cm in diameter are superior to those that are 8 cm. Infant paddles or pads are to be used for smaller infants weighing <10 kg. |
| • When using paddles, use conductive materials such as electrode cream or paste to decrease transthoracic impedance. |
| • Interface materials that should not be used include saline, alcohol, and ultrasound gel, as well as the use of bare paddles. |
| • Paddles and electrode pads must not contact each other and care must be taken to avoid interface materials on one side of the chest contacting the material placed on the opposite side. |
| • The optimal energy dose for defibrillation in children has not been established. For manual defibrillators, use 2 J/kg for the first attempt, 4 J/kg for the second attempt, and 4 J/kg or higher for subsequent attempts. |
| • For synchronized cardioversion, use 0.5 to 1 J/kg for the first attempt and 2 J/kg for subsequent attempts. |
| • For AEDs, for children older than 8 years, a standard AED without a dose attenuator should be used. For those 1 to 8 years of age, an initial pediatric attenuated dose should be used. If it is the only device available, a standard AED without a dose attenuator is acceptable for those 1 to 8 years of age. |
| • To avoid fires, all oxygen sources must be removed from the patient before defibrillation. |
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