FAQ

Fortunately, sudden cardiac arrest (SCA) in school-age children is rare. Resuscitation attempts at schools are more likely to be made on an adult (staff member or visitor) than a pupil. The presence of an AED at a school therefore provides potential benefit for everyone present at the site.

An additional and important advantage of having an AED prominently located at a school is that students become familiar with them and can learn about first aid, resuscitation and the purpose of defibrillation.

The Department of Education has issued guidance about the installation of AEDs in schools.

Yes. The incidence of shockable rhythms requiring defibrillation in children is very low but can occur. The priority must always be for high-quality CPR and getting expert help. However, the AED can be used across all age groups if this is the only available machine.

The paediatric advanced life support Guidelines 2015 state that if using an AED on a child of less than eight years, a paediatric attenuated shock energy should be used if possible. 

Experience with the use of AEDs (preferably with dose attenuator) in children younger than one year is limited. The use of an AED is acceptable if no other option is available as, on balance, it is probably better to give a 50 J shock than nothing at all. The upper safe limit for dosage in this group is unknown.

Fortunately, out-of-hospital cardiac arrest (OHCA) in childhood is a rare event. Studies of OHCA in children and adolescents (excluding infants under one year old) report an incidence between 3 and 9 per 100,000 per year. The rates reported in infants are generally much higher (between 11 and 72 per 100,000 infants per year). The cause in this latter group is often attributed to the Sudden Infant Death Syndrome (SIDS).

The incidence of cardiac arrest from a primarily cardiac cause (which includes cases referred to as “sudden cardiac arrest” or SCA) has been reported to be 2 – 3 per 100,000 per year in children and adolescents. SCA is more common in boys than girls, and more likely to occur during or just after sporting activity. 

Warning symptoms for future SCA may include previous episodes of collapse or near-collapse, dizziness, palpitations, chest pain, shortness of breath or unexplained episodes of brief seizure-like activity. Such symptoms may not always be present, however, and can be difficult to interpret in the setting of sporting activity, where those participating may often be pushing themselves to the point of exhaustion. A family history of cardiovascular disease and unexplained death at a young age may also be highly relevant.

Survival rates of 1.9 – 11.1% following attempted resuscitation have been reported, with good neurological outcomes in many. Survival is more likely with witnessed events and a shockable rhythm on first ECG analysis – conditions often seen when an arrest occurs in a public location, like a school.

The core principles of CPR – ventilation to provide breathing and chest compressions to support the circulation – apply equally to children and adults.

Many children do not receive CPR because potential rescuers are not sure if there are specific methods recommended for children, and are afraid of causing harm. This fear is unfounded; it is far better to use the adult CPR sequence for the resuscitation of a child than to do nothing. When performing chest compressions, compress the child’s chest by 1/3 to 1/2 of its depth – don’t be afraid to push hard.

Although slightly different techniques are taught to those people (particularly healthcare workers) who have special responsibilities for the care of children, the differences are not crucial, and it is far more important to do something using the techniques you have been taught.

While there are a number of possible causes, three are particularly common in the UK. The first is Hypertrophic Cardiomyopathy (HCM), a genetic heart muscle condition in which the walls of the heart’s left ventricle become abnormally thickened. This can obstruct blood flow from the heart, causing loss of consciousness and a dangerous arrhythmia leading to cardiac arrest. The second is Long QT Syndrome, an often-unrecognised inherited condition affecting the heart’s electrical system that can predispose young people to life-threatening arrhythmias. Episodes are most commonly triggered by physical exertion or emotional stress. The third is commotio cordis, an electrical disturbance triggered by a sharp blow to the chest at a critical moment in the heart’s cycle. It can occur in contact sports such as football, cricket, rugby, and martial arts, as well as any situation involving a forceful blow to the chest.