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Prescribing an automated external defibrillator for children at increased risk of sudden arrhythmic death

Published online by Cambridge University Press:  13 June 2017

Karen A. McLeod ,
Eileen Fern ,
Fiona Clements  and
Ruth McGowan
Karen A. McLeod*
Affiliation:
Departments of Cardiology and Clinical Genetics, Royal Hospital for Children, Queen Elizabeth University Hospitals, Glasgow, G51 4TF, United Kingdom
Eileen Fern
Affiliation:
Departments of Cardiology and Clinical Genetics, Royal Hospital for Children, Queen Elizabeth University Hospitals, Glasgow, G51 4TF, United Kingdom
Fiona Clements
Affiliation:
Departments of Cardiology and Clinical Genetics, Royal Hospital for Children, Queen Elizabeth University Hospitals, Glasgow, G51 4TF, United Kingdom
Ruth McGowan
Affiliation:
Departments of Cardiology and Clinical Genetics, Royal Hospital for Children, Queen Elizabeth University Hospitals, Glasgow, G51 4TF, United Kingdom
*
Correspondence to: Dr K. A. McLeod, MD, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, United Kingdom. Tel: +44 141 451 6508; Fax: +44 141 201 2215; E-mail: karen.mcleod@ggc.scot.nhs.uk
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Abstract

Background

Automated external defibrillators can be life-saving in out-of-hospital cardiac arrest.

Objective

Our aim was to review our experience of prescribing automated external defibrillators for children at increased risk of sudden arrhythmic death.

Methods

We reviewed all automated external defibrillators issued by the Scottish Paediatric Cardiac Electrophysiology Service from 2005 to 2015. All parents were given resuscitation training according to the Paediatric Resuscitation Guidelines, including the use of the automated external defibrillator.

Results

A total of 36 automated external defibrillators were issued to 36 families for 44 children (27 male). The mean age at issue was 8.8 years. Diagnoses at issue included long QT syndrome (50%), broad complex tachycardia (14%), hypertrophic cardiomyopathy (11%), and catecholaminergic polymorphic ventricular tachycardia (9%). During the study period, the automated external defibrillator was used in four (9%) children, and in all four the automated external defibrillator correctly discriminated between a shockable rhythm – polymorphic ventricular tachycardia/ventricular fibrillation in three patients with one or more shocks delivered – and non-shockable rhythm – sinus rhythm in one patient. Of the three children, two of them who received one or more shocks for ventricular fibrillation/polymorphic ventricular tachycardia survived, but one died as a result of recurrent torsades de pointes. There were no other deaths.

Conclusion

Parents can be taught to recognise cardiac arrest, apply resuscitation skills, and use an automated external defibrillator. Prescribing an automated external defibrillator should be considered for children at increased risk of sudden arrhythmic death, especially where the risk/benefit ratio of an implantable defibrillator is unclear or delay to defibrillator implantation is deemed necessary.

Keywords

Sudden deatharrhythmiaautomated defibrillatorchildren
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 7 , September 2017 , pp. 1271 - 1279
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Copyright
© Cambridge University Press 2017 

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