Ventricular fibrillation is an unusual rhythm in children. It may occur during electrophysiological studies or in children with congenital heart disease, or other predisposing conditions. In the arrest situation, once identified, ventricular fibrillation or pulseless VT should be defibrillated as soon as possible. Reversible causes should be then be sought including: hypothermia, electrolyte abnormalities or drugs such as tricyclic antidepressants.
The protocol is shown below and should be carried out in the context of active basic life support.
One should note that with defibrillation, when selecting the charge in relation to weight, it may not be possible to select the precise energy in which case the nearest energy should be chosen. Paediatric paddles (4.5 cm) should be used in infants (less than 1 year). For children, adult paddles (12.5 cm) may be used. Normally these should be placed beneath the right clavicle and to the left of the sternum over the cardiac apex. If defibrillation is initially unsuccessful, in addition to remedying any cause, consideration should be given to changing the position of the paddles to anteroposterior. Anteroposterior positioning of paddles may also be used when having to use adult paddles to defibrillate infants..
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