The role of defibrillation in basic life support
Modern clinical guidelines, including standards from the European Resuscitation Council (European Resuscitation Council, ERC), mandate that defibrillation be performed as early as possible. Thanks to public access defibrillation programs, automated external defibrillators (AEDs) are now placed in high-traffic public areas such as railway stations, airports, and shopping malls.
Equipment storage areas are marked with a standardized international symbol: a green square featuring a white heart outline, a lightning bolt, and a cross. Widespread availability of these devices has led to a classification change: early defibrillation is now officially included in the Basic Life Support (BLS) algorithm. This procedure is no longer exclusively performed by specialized emergency teams and can be carried out by individuals without professional medical training.
Device preparation and action algorithm
Working with the device comes down to strictly following its voice prompts. The device must be placed directly next to the victim to ensure unobstructed access to the control panel. The patient's chest must be completely bared to ensure firm electrode-to-skin contact.
After turning on the defibrillator (some models activate automatically when the lid is opened), the rescuer's further actions are fully coordinated by voice instructions and visual pictograms. The electrodes are placed according to a strict anatomical scheme:
- Right electrode: placed on the anterosuperior chest wall, directly below the right clavicle.
- Left electrode: placed on the anterolateral surface of the left hemithorax, over the cardiac apex.
As soon as the electrodes are secured, the AED independently initiates ECG rhythm recording and analysis. If the built-in algorithm detects a shockable rhythm (e.g., ventricular fibrillation), the device will charge and recommend delivering a shock.
Age-related features and energy selection
The tactics for using equipment in pediatrics strictly depend on the patient's age. The main principle is controlling the energy of the delivered shock, measured in joules (J).
- Children over 8 years and adults: Standard defibrillators with standard energy settings ranging from 100 to 200 J are used.
- Children aged 1 to 8 years: The preferred approach is to use AEDs equipped with a power reduction feature (up to 50–75 J) or specialized pediatric electrodes. If adapted equipment is unavailable in an emergency, standard adult devices may be used as an alternative.
- Infants (under 1 year): A strict rule applies. Only devices with a forced energy reduction function may be used. Manual (non-automated) defibrillators, where the medical professional manually sets the required energy, are also permitted.
Safety precautions
To prevent electrical injury to the rescuer and avoid distortions in ECG data, basic safety measures must be followed. Before starting, ensure the child's body is free of any contact with liquids (water) as well as conductive surfaces or objects.
It is strictly forbidden to touch the patient at two critical moments:
- During the device's heart rhythm analysis (any contact can cause artifacts and misinterpretation of the electrocardiogram).
- Precisely at the moment of delivering the electrical shock.
Basic CPR parameters
National pediatric emergency guidelines outline strict criteria for resuscitation measures accompanying defibrillation. When CPR is performed by two rescuers (healthcare providers), the standard pediatric ratio is applied: 15 chest compressions to 2 rescue breaths (15:2).
To maintain adequate artificial circulation, the chest compression rate must be strictly 100 to 120 per minute. Meanwhile, the adequacy of artificial pulmonary ventilation is assessed visually: a reliable sign of a successful breath is visible chest excursion, meaning the victim's chest rises.
Electrode placement rule: "Right under the collarbone, left on the apex."
Class and exam questions
Can a standard adult AED be used for a 5-year-old child?
Yes, in an emergency. Although using devices with reduced energy (50–75 J) or pediatric electrodes is preferred, a standard defibrillator may be used if they are unavailable.
Why is it forbidden to touch the patient while the AED is operating?
Physical contact during rhythm analysis leads to artifacts and device errors, while touching the patient during the shock can cause severe electrical injury to the rescuer.
How to verify the effectiveness of artificial ventilation?
Adequacy of ventilation during artificial respiration is always assessed visually. A reliable criterion for successful ventilation is visible chest excursion (rising) in the child.
What else to study on this topic
- Pathophysiology of ventricular fibrillation in children
- Differences between manual and automated defibrillators
- Impact of artifacts on ECG rhythm analysis by the device
- Technical specifications of shock energy output in AEDs
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