Pediatric Defibrillation: Importance of Paddle Size in Determining Transthoracic Impedance

Transthoracic impedance is a major determinant of successful defibrillation or cardioversion, but no data are available concerning the range and determinants of transthoracic impedance in children. Transthoracic impedance was measured in ten ambulatory infants, 6 weeks to 9 months of age, and 37 children, 1.5 to 15 years of age, using a previously validated "test pulse" technique that measures transthoracic impedance without actually delivering a shock. We used hand-held "pediatric" (21 cm2) and "adult" (83 cm2) electrode paddles coated with either Redux paste or Redux creme. Transthoracic impedance in children was 108 ± 24 Ω (range 61 to 212 Ω) using pediatric paddles. Using adult paddles lowered the transthoracic resistance by 47% to 57 ± 11 Ω (range 29 to 101 Ω), P < .05. In infants, transthoracic impedance (measured only with pediatric paddles) was 94 ± 17 Ω (range 74 to 124 Ω). Using Redux paste as the coupling agent reduced transthoracic impedance by 13% (P < .05). Transthoracic impedance was significantly but poorly related to body weight and body surface areas, but the correlations were not sufficiently high to be clinically useful. These data indicate that the larger adult electrode paddles will minimize transthoracic impedance and should be used when the child's thorax is large enough to permit electrode to chest contact over the entire paddle surface. This transition occurred at an approximate weight of 10 kg.