自動體外心臟電擊器可適用於兒童


  June 30, 2003-根據發表在七月一日的《循環與小兒科》期刊(Circulation and Pediatrics)的美國心臟學會一項醫學聲明指出,自動體外心臟電擊器(AEDs)可以用在一到八歲兒童身上。
  
  這項醫學聲明的主要作者是來自美國土桑市亞利桑納大學的Ricardo Samson,他表示AEDs是成人心跳停止的第一線療法,直到最近都只用在八歲以上的人身上,在不可避免的情況下,AEDs可以搶救年輕的生命,應用到更小的兒童身上,也可以搶救更多兒童的生命。
  
  在這項聲明發表之前,小於八歲的兒童可以在醫院接受手動體外電擊去顫術,但不能用設計給急救人員及非專業的人使用的家用電擊器。
  
  Samson博士表示,一般來說,兒童心跳停止需要等待有經驗的醫療人員,來評估其心跳是否需要接受電擊,而對成人來說愈早接受電擊,生存的機率愈大,根據Samson博士表示,如果延遲電擊時間,成人的存活率每分鐘減少7%到 10%,而且若電擊延遲超過十二分鐘,存活率少於5%。
  
  評估兒童使用AED的文獻之後,該聲明的作者認可過去的指導方針,沒有足夠的證據顯示,可以在小於一歲的兒童身上使用AEDs,且施救者應該先進行一分鐘的心肺復甦術(CPR),因為有些沒有心臟問題的昏迷兒童,可能只需要外來的呼吸輔助就可以救活,然而,他們建議對已有心室纖維顫動的狀況進行電擊,
  雖然AEDs原先是設計給成人使用,最近的研究顯示它也可以精確的診斷兒童的心跳,且有一些AED製造商提供較小型的電極墊及電線,可以降低震動程度,以便更適用於兒童身上。
  
  Samson表示,因此他們發表聲明認為AEDs現在可以用在心跳停止的兒童身上,最小可以到一歲,他同時表示,即使AED的電極墊不是專門給小兒科使用,也可以用在一歲以上的兒童身上。
  
  這個專門小組鼓勵製造商測試AEDs的心跳偵測軟體,對照兒童心跳的記錄,以建立小兒心跳診斷程式,並繼續研究努力,決定對兒童最佳效果的AED能量。
  
  Samson博士表示,重要的是讓更多人接受CPR及AED使用的訓練,因為特殊地點的反應計畫可以確定AED達到遇難者,根據報告,曾出現有AED但兒童仍死亡,因為沒有受過訓練的人員懂得使用。

Automated External Defibrillat

By Laurie Barclay, MD
Medscape Medical News

June 30, 2003 — A scientific statement from the American Heart Association, published in the July 1 issues of Circulation and Pediatrics, supports use of automated external defibrillators (AEDs) in children aged 1 to 8 years.

"AEDs are the first line of treatment for cardiac arrests in adults. Until recently, they were only approved for people age 8 and older," lead author Ricardo Samson, MD, from the University of Arizona in Tucson, says in a news release. "In those cases where it's necessary, AEDs can save a young person's life. Extending their use to younger children may mean more children's lives may be saved."

Before this statement was issued, children younger than eight years could receive manual defibrillation at a hospital, but not with home defibrillators designed for use by emergency personnel or lay responders.

"Typically, a child in cardiac arrest would have to wait for experienced medical personnel to evaluate if the rhythm required a shock," Dr. Samson says. "What has been shown in adults is that the earlier they receive a shock, the greater the chances of survival."

Survival in adults decreases by 7% to 10% for every minute that defibrillation is delayed, according to Dr. Samson, and it is less than 5% when defibrillation is delayed by more than 12 minutes.

After reviewing the literature on AED use in children, authors of the statement endorsed previous guidelines that there is insufficient evidence for use of AEDs in children younger than one year, and that lone rescuers should first attempt one minute of cardiopulmonary resuscitation (CPR) before any other action on children, because some unconscious children without cardiac problems may be resuscitated by rescue breaths alone. However, they recommend defibrillation for documented ventricular fibrillation.

Although AEDs were originally designed for adults, recent studies suggest that they can accurately diagnose cardiac rhythms in children, and some AED manufacturers provide smaller electrode pads and cables that reduce the shock to a level that may be more suitable for younger children.

"With that information, we are issuing the statement that AEDs can now be used on children with no signs of circulation as young as one year of age," Dr. Samson says. He adds that even an AED without pediatric electrode pads can be used on children at least one year of age.

The task force encourages manufacturers to test their rhythm detection software in their AEDs against libraries of previously recorded pediatric rhythms, to develop pediatric rhythm diagnostic programs, and to continue research efforts to determine the optimum AED energy dose in children.

"It's important that more people are trained in CPR and AED use. Site-specific response plans must also be in place to ensure that an AED gets to the victim," Dr. Samson says. "There have been situations reported where an AED was available but a child died because there was no one trained to retrieve and use the device."

Circulation. 2003;107:000-000

Reviewed by Gary D. Vogin, MD

    
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