The findings, published in JAMA Network Open, highlight the need to improve automated external defibrillator availability and use in locations where children gather, particularly schools, and provide important evidence for developing strategies to increase early AED application in pediatric cardiac arrest.
Out-of-hospital cardiac arrest in children is associated with poor survival, and rapid intervention before emergency medical services (EMS) arrive is crucial. While early defibrillation is known to improve outcomes in shockable cardiac rhythms, little has been known about how often AED pads are applied before EMS arrival in pediatric cases or whether this practice influences survival.
To address this question, Aoi Yamaguchi from the Faculty of Medicine, The University of Osaka, Japan, and colleagues conducted a nationwide, prospective, population-based cohort study using data from the All-Japan Utstein Registry. The analysis included pediatric patients aged 0 to 17 years who experienced OHCA between 2021 and 2023 and received resuscitation attempts before EMS arrival. In total, 3,352 children were included in the study.
The researchers assessed the frequency of AED pad application before EMS arrival and examined factors associated with its use. They also evaluated one-month survival with a favorable neurological outcome, defined as a Cerebral Performance Category score of 1 or 2.
Key findings of the study include:
- Only 185 of 3,352 children (5.5%) received AED pad application before EMS arrival.
- AED pads were less likely to be applied in infants, younger children, during nighttime, and when cardiac arrest occurred at home.
- AED pad application was more common when cardiac arrest occurred at school and when bystander cardiopulmonary resuscitation (CPR) had already been initiated.
- Children who received AED pad application before EMS arrival had more than threefold higher odds of surviving one month with a favorable neurological outcome compared with those who did not receive early AED pad application.
- Ventricular fibrillation as the first documented heart rhythm was strongly associated with improved neurological survival.
The findings suggest that early AED pad application may improve outcomes after pediatric out-of-hospital cardiac arrest, with schools emerging as key locations for timely AED use. The researchers noted that wider AED availability and trained bystanders could help increase early intervention.
The study had several limitations, including possible misclassification of AED pad application, unmeasured factors such as AED availability, rescuer expertise, and time to AED use, and limited generalizability outside Japan.
Overall, the researchers concluded that although pre-EMS AED pad application remains uncommon, it is associated with significantly better neurological survival. They called for expanded AED access in schools and other child-focused public settings, along with greater public education and awareness to encourage timely AED use in pediatric emergencies.
Reference:
Yamaguchi A, Fukuzawa A, Atsuta M, et al. Automated External Defibrillator Pad Application Before EMS Arrival in Pediatric Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2026;9(7):e2625069. doi:10.1001/jamanetworkopen.2026.25069
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