Lay rescuer use of automated external defibrillators in infants, children and adolescents: A systematic review.

IMPORTANCE

Automated external defibrillator (AED) use is increasing, but use in children is uncommon. A growing literature of use in children by lay rescuers warrants review.

OBJECTIVE

A systematic review of AED effectiveness in children experiencing out-of-hospital cardiac arrest (OHCA).

DATA SOURCES

PubMed, EMBASE, Cochrane Register of Controlled Trials.

STUDY SELECTION

Children, ages 0-18, experiencing OHCA with an AED applied by a lay rescuer. Control population: children with no AED application.

DATA EXTRACTION AND SYNTHESIS

Results are reported according to PRISMA guidelines. Two authors independently reviewed all titles and abstracts of references identified by the search strategy, then generated a subset which all authors reviewed.

MAIN OUTCOMES AND MEASURES

Critical outcomes were survival with Cerebral Performance Category (CPC) 1-2 at hospital discharge or 30 days and survival to hospital discharge.

RESULTS

Population: age categories: <1 year, 1-12 years, 13-18 years. Lay rescuer AED application resulted in improved survival with CPC 1-2 at hospital discharge or 30 days to hospital discharge in age groups 1-12 and 13-18 years (RR 3.84 [95 % CI 2.69-5.5], RR 3.75 [95 %CI 2.97-4.72]), respectively and hospital discharge in both groups(RR 3.04 [95 % CI 2.18-4.25], RR 3.38 [95 % CI 2.17-4.16]), respectively. AED use with CPR improved CPC 1-2 at hospital discharge and hospital discharge (RR 1.49 [95 % CI 1.11-1.97], RR 1.55[1.12-2.12]).

CONCLUSIONS

AED application by lay rescuers is associated with improved survival with a CPC of 1-2 at 30 days, and improved survival to hospital discharge for children 1-18 years. There are limited data for children < 1 year.