Key result
Using adult electrode paddles for pediatric defibrillation resulted in significantly higher peak current flow (8.7 vs 6.2 amps, P<0.002) and lower transthoracic impedance compared to pediatric paddles.
Why the study?
Does the use of "adult" electrode paddles improve peak current flow and reduce transthoracic impedance compared to "pediatric" paddles in pediatric patients undergoing defibrillation or cardioversion?
Observational (n=20)
No
Does the use of "adult" electrode paddles improve peak current flow and reduce transthoracic impedance compared to "pediatric" paddles in pediatric patients undergoing defibrillation or cardioversion?
Absolute Event Rate: 8.7% vs 6.2%
p-value: p=<0.002
Using adult electrode paddles in pediatric defibrillation significantly reduces transthoracic impedance and increases peak current flow compared to pediatric paddles.
Adult paddles may enhance current delivery in children; hypothesis-generating and should not yet change practice.
OBJECTIVE: Current flow, the major determinant of defibrillation success, depends on delivered energy and transthoracic impedance. Previous experimental data suggest that transthoracic impedance is higher using "pediatric" electrode paddles compared to the larger "adult" electrode paddles. There are few data from actual shocks to support the experimental studies. The purpose of this study was to measure transthoracic impedance during actual shock delivery and to determine the optimal electrode paddle size for pediatric defibrillation and cardioversion. METHODS: We prospectively evaluated all shocks of < or = 20 joules given to pediatric patients at the University of Iowa from 1988 to 1992. Data collected included energy selected by the operator, energy delivered by the defibrillator, peak current flow and transthoracic impedance. Data were analyzed by unpaired t test and linear regression. RESULTS: Fifty-five shocks were delivered to 20 patients, age newborn to 8 years. Thirty-seven shocks were given with "pediatric" electrode paddles (surface area 21 cm2) and 18 with "adult" electrode paddles (surface area 83 cm2). Selected energy correlated well with delivered energy (r = .98, P < .0001). Delivered energy using "pediatric" electrodes did not differ from that delivered with "adult" electrodes (8.0 +/- 0.9 joules vs 10.5 +/- 1.2 joules P > .1). However transthoracic impedance was significantly higher with "pediatric" electrodes (78.1 +/- 4.4 ohms vs 54.6 +/- 2.7 ohms P < .0008), resulting in lower peak current flow through "pediatric" electrode paddles (6.2 +/- 0.5 amps vs 8.7 +/- 0.5 amps P < .002). There was no correlation between joules/kg and peak current flow (r = .26, P > .05). CONCLUSION: Use of "pediatric" electrode paddles results in higher transthoracic impedance and thus lower peak current flow. In pediatric defibrillation, larger "adult" electrode paddles should be used as soon as chest size permits (approximately 10 kg). Lower transthoracic impedance results in higher current flow that facilitates cardioversion and defibrillation.
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Atkins et al. (1994) conducted an observational in Pediatric defibrillation and cardioversion (n=20). "Adult" electrode paddles vs. "Pediatric" electrode paddles was evaluated on Peak current flow (p=<0.002). Using adult electrode paddles for pediatric defibrillation resulted in significantly higher peak current flow (8.7 vs 6.2 amps, P<0.002) and lower transthoracic impedance compared to pediatric paddles.
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