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Automated External Defibrillator use in the General Pediatric Clinic

Presented By:

(1)Stephanie-Grace Raymundo, MD (1), Megan McKittrick, MD (2), Jeremy Moore, MD MS FACC (2)

(1) Pediatric Cardiology, Helen DeVos Children’s Hospital, Grand Rapids, MI; (2) Pediatric Cardiology, UCLA Mattel Children’s Hospital, Los Angeles, CA

mmckittrick@mednet.ucla.edu

Overview:

BACKGROUND: Children with medical issues will often initially present to their general pediatrics clinic. A national survey of general pediatricians showed that in office emergencies can occur as often as once a month, and of those, approximately 10% were reported to consist of cardiac arrhythmia or arrest. Automated external defibrillator (AED) defibrillation combined with early CPR results in a survival rate of up to 74% for children with out of hospital arrests. The American Academy of Pediatrics (AAP) has published official recommendations that general pediatrics clinics possess AEDs for emergency use. However, there are currently no comprehensive studies investigating the specific presence or use of AEDs for SCA in general pediatric clinics. This study surveyed general pediatricians on the presence, perception, and use of on-site AEDs. METHODS: An electronic survey was distributed through SurveyMonkey® to 10,865 members of the AAP Listserv. Data were collected into RedCap® and analyzed with R for Macintosh. RESULTS: 53 of 10,865 responded (0.4%). The majority of respondents practiced in a community (87%) rather than academic setting. 38 (62%) were employed in stand-alone pediatrics clinics, while the remainder worked in a combined medicine-pediatrics setting. 48 (91%) worked in an urban community. Most respondents reported access to an AED on clinic premises (87%), and 92% agreed that easy access to on-site AEDs was important. Those employed in a combined medicine-pediatrics clinic were more likely than their stand-alone clinic counterparts to have on-site access to AEDs (p = 0.02). There was not a significant correlation between AED access across location (p > 0.05) or practice setting (p > 0.05). Amongst those who did not have access to on-site AEDs, the most common barriers were high cost of machine (71%) and infrequency of use (71%). CONCLUSIONS: The majority of combined and stand-alone pediatrics clinics report on-site access to AEDs in case of SCA. Cost of AEDs and their routine maintenance, as well as perceived infrequency of cardiac events in pediatric patients were among the barriers preventing universal AED access in clinics. Addressing cost-effectiveness and providing education around the relative frequency of pediatric cardiac emergencies and importance of early resuscitation could encourage increased access to AEDs in pediatrics clinics.