In pediatric cardiac arrest, when is defibrillation indicated?

• A. Defibrillation is never indicated in pediatric arrest.
• B. Defibrillate only for a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia); asystole/PEA are non-shockable.
• C. Defibrillation should be used only after epinephrine administration.
• D. Defibrillation is indicated for any rhythm presenting during arrest.

Answer: (B)

In pediatric arrest, defibrillation is used only when the rhythm is shockable. Ventricular fibrillation and pulseless ventricular tachycardia are rhythms that can be interrupted by a delivered shock, which may allow the heart to regain an organized, effective rhythm and restore perfusion. If the rhythm is asystole or pulseless electrical activity, there is no organized electrical activity or no effective cardiac output, so a shock won’t help and should not be used. In those non-shockable situations, the focus is on high-quality CPR and rapid medical interventions (like epinephrine and addressing reversible causes) while continuing rhythm checks to detect a shockable change. So defibrillate when you detect a shockable rhythm, and do not defibrillate for non-shockable rhythms.