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.