Thank you to Kim for the following question:

I wonder if you can clarify something for me? From memory the old ARC Guidelines used to state that we do not defibrillate infants (under 1 year). The new ANZCOR Guideline 7, 4.2 does not clearly say DO NOT use on infants. What is your knowledge and opinion on this?

Response provided by Dr Natalia Hood (Australian Resuscitation Council)

The current recommendation of the ARC is that when no manual (dial up a per kilo energy level) defib is available, the next best option is an AED with paediatric pads or an attenuation key, and the last best option is to use the adult AED.

A cardiac arrest in an infant under one year, outside hospital, is very rare.  Of the cardiac arrests that occur in children, 90% are due to a cause other than a primary cardiac arrhythmia.  Only 10% of paediatric cardiac arrests are going to need defibrillation.  That means, chances are that even if you used an adult AED on an infant, 9 times out of 10, no shock by the AED will be recommended.  Instead the AED prompts will say to continue CPR and observe for signs of life.

If an infant (or any person for that matter) is in a cardiac rhythm requiring defibrillation, CPR alone will not save their life.  Just giving CPR means that they will die.  For an infant in a defibrillating rhythm, if no AED at all is used, then the infant will die if all you are doing is giving CPR.

Using an adult AED on an infant will be against the manufacturers’ recommendations as it is thought to risk harm to the small infant heart plus the adult units have not been tested on infants.  If it is likely that an ambulance will arrive immediately with an infant AED or defibrillator then the best option may well be to do CPR and wait for the infant AED but in remote locations or when the ambulance response time is unknown then the best option for the infant’s survival is using the adult AED.

The ARC has had others question for this also and is looking to produce an FAQ to put on its website.