Fire Attributable to a Defibrillation Attempt in a Neonate

A fire can occur during a defibrillation attempt because a spark can be generated in an oxygen-enriched atmosphere. Although the risk is small, a fire during patient care can have devastating effects. We describe a case of a fire attributable to a defibrillation attempt in a 10-day-old neonate following open-heart surgery. To our knowledge, this is the first published account of a fire during a defibrillation attempt in an infant or child. We review predisposing factors and preventive strategies, with special emphasis on the importance of removing oxygen from the immediate environment during defibrillation attempts. Fire is a rare but potentially devastating complication of defibrillation attempts.1–3 Despite the severe consequences of patient fires, this risk is not mentioned in standard critical care4,5 or cardiology textbooks,6,7 presumably because of the paucity of clinical reports.1,8,9 We present a case of a fire ignited by a defibrillation attempt in a 10-day-old infant, and discuss the contributing factors and recommended preventive measures. To our knowledge, this represents the first such report in an infant or child. The patient was a term newborn with a type II truncus arteriosus. Surgical correction on day 10 of life was complicated by myocardial ischemia attributable to an anomalous descending coronary artery that was severed during the surgery. Following the repair, the chest was left open and the median sternotomy was covered with a Gore-Tex tissue patch. She returned to the pediatric intensive care unit in an infant warmer and required high ventilator settings including fraction of inspired oxygen of 1.0, positive end-expiratory pressure of 12 cm H2O, tidal volume of 80 mL, and a respiratory rate of 20 breaths per minute. She was also provided with considerable inotropic support including epinephrine, dopamine, … Reprint requests to (A.A.T.) Department of Pediatrics, University of Arizona, 1501 N Campbell Ave, Room 3302, Box 245073, Tucson, AZ 85724-5073. E-mail: aat{at}peds.arizona.edu