In pediatric defibrillation, should I round-up, or down with available joule settings? For example, for a 10-month-old who weighs approximately 9.5kg, the initial suggested energy setting would be 19 Joules, followed by 38 Joules. Lifepack allows 15,20,30,50 Joules.

SWORBHP Medical Council suggests rounding to the nearest (either up or down) Joule settings. In the situation you describe 20 joules as the first shock, then 30 joules for the second and subsequent dosing.

There is currently a paucity of evidence on recommended initial and subsequent dosing for refractory shockable rhythms in arrest in the pediatric population. A recent systematic review found no relationship between energy dose and outcome. Doses from 1J/kg to 9J.kg have been studied with no clear answer. The AHA guidelines currently align with the Cardiac Arrest Medical Directive with a suggested initial starting dose of 2J/kg and initial shocks at 4J/kg.  Given this evidence for lack of a specific dosing, and the current guidelines, we suggest rounding to the closest Joule settings, as stated above.

Eric Mercier, et al. Defibrillation energy dose during pediatric cardiac arrest: Systematic review of human and animal model studies. Resuscitation, Volume 139,2019,Pages 241-252.

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defibrillation, medical cardiac arrest, Pediatrics

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