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US and International guidelines differ on the initial defibrillation dose in pediatric patients. International, European, Australian and New Zealand guidelines had recommend an initial dose of 4 J/kg for the initial and all subsequent doses while the American Heart Association recommends an initial dose of 2-4J/kg (with 2 J/kg in the teaching algorithms) with subsequent shocks being at least at 4J/kg and no greater than 10 J/kg. More recently, ILCOR suggested an initial dose of 2-4 J/kg.
This was a systemic review of 7 observational studies, mostly involving in hospital pediatric cardiac arrests. Outcomes of termination of VF/pVT, ROSC and survival to hospital discharged were examined in relation to the initial J/kg dose that was used compared to initial doses of 2 J/kg. Outcomes were neither better or worse with doses < 1.5 J/kg or > 2.5 J/kg. Additional research is needed as this certainty of this evidence was considered “very low.”
References
Acworth J, Del Castillo J, Tiwari LK, Atkins D, de Caen A, Bansal A, Couto TB, Katzenschlager S, Kleinman M, Lopez-Herce J, Morgan RW, Myburgh M, Nadkarni V, Tijssen JA, Scholefield BR; International Liaison Committee on Resuscitation Paediatric Life Support Task Force. Energy doses for paediatric defibrillation in cardiac arrest: systematic review and meta-analysis. Resusc Plus. 2025 May 26;24:100991. doi: 10.1016/j.resplu.2025.100991. PMID: 40524976; PMCID: PMC12169708.