Hands-On Defibrillation - A Safer Way?

Written by Sam Parnell

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Polyethylene drapes used as a physical barrier to cover patients during defibrillation reduced electrical current to acceptable levels for medical personnel to continue compressions throughout defibrillation during cardiac arrest.

Why does this matter?
Cardiopulmonary resuscitation (CPR) remains a cornerstone of cardiac arrest management. High quality chest compressions allow for adequate cerebral and coronary perfusion and increase the chance of neurologically intact survival. Current ACLS and AHA guidelines strongly recommend that every effort be made to minimize interruptions during CPR. However, CPR often has to be paused for defibrillation when the patient is in ventricular tachycardia (VT) or ventricular fibrillation (VF). Is there a way to safely continue compressions while delivering a shock?

Will we still be saying “clear” before delivering a shock in five years?
This was a single center study that assessed the effectiveness of 2-millimeter-thick polyethylene drapes during elective cardioversion. An external defibrillator delivered a biphasic shock between 200-360 J in 23 cases. The mean current leak was 0.07 +/- 0.02 mA and the mean peak current leak was 0.67 +/- 0.21 mA. Both current leaks were well below accepted IEC safety standards. As physiologic confirmation of these findings, 10 shocks were delivered with investigators (that no one really liked that much anyway) in contact with the polyethylene drapes. None of the shocks were perceptible.

This study did not address how wet contact between surfaces or the physical stress of compressions affect polyethylene drapes and if they remain a safe electrical barrier during actual CPR. Additional studies are needed before polyethylene drapes make it to prime time and are placed on every patient in cardiac arrest. However, it is quite possible that in 5-10 years having to “clear” a patient and stop CPR during defibrillation will be a thing of the past. In the meantime, focus on charging the defibrillator before pulse checks and providing compressions between the pulse check and defibrillation to maximally reduce the peri-shock pause.

Source
Hands-on defibrillation with a safety barrier: An analysis of potential risk to rescuers. Resuscitation. 2019 Mar 9;138:110-113. doi: 10.1016/j.resuscitation.2019.02.043. [Epub ahead of print]

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Reviewed by Thomas Davis

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