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Automated external defibrillation to detect the heart rate in children, comparing those under and over five years of age.
In children with out-of-hospital cardiac arrest, the rhythm immediately preceding return of spontaneous circulation can be significant. We compared rhythms detected by automated external defibrillator (AED) analysis of chest compressions performed by 911 emergency dispatchers to rhythms analyzed by an independent hospital-based AED device. We also determined if there were differences in efficacy of manual defibrillation by Emergency Medical Service (EMS) paramedics based on age. A total of 782 children treated by EMS for cardiac arrest were retrospectively selected. All children had a cardiac rhythm obtained by paramedics prior to hospital arrival. Those with a shockable rhythm were treated with a defibrillator. All ECG tracings were analyzed to determine the initial recorded rhythm. Data from an automated external defibrillator (AED) stationed at the hospital and another AED on the scene were interpreted to evaluate for any differences in the recorded rhythm, responsiveness to cardioversion, and results from the manual defibrillation attempts. Among children under five years of age, the AED and EMS rate of shockable rhythms were similar (AED, 50 of 194, 25% and EMS, 48 of 194, 25%). Among children over five years of age, the AED and EMS shockable rhythms were similar (AED, 18 of 87, 20% and EMS, 19 of 87, 22%). Among children over five years of age, EMS paramedics were more likely to deliver a second defibrillation with the same waveform; the difference in the rate of second defibrillation was not statistically significant between those under five years of age. Shockable rhythms recorded on-scene by EMS paramedics in the older group were more likely to be sustained arrest than rhythms of similar duration in the younger group (P = 0.0081). Rates of shockable rhythms obtained by on-scene AED analysis in children under five years of age are similar to those recorded by paramedics. In those older than five years of age, EMS paramedics were more likely to attempt a second defibrillation and were more likely to resuscitate children with an initial rhythm of asystole compared to children under five years.Structure of sphingosine kinase-2 and the role of the kinase in apoptosis.

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