Written by Sam Parnell
Hands-on defibrillation during CPR appears to be safe if appropriate electrical insulating barriers such as polyethylene gloves or drapes are used.
Why does this matter?
Minimizing interruptions in chest compressions during CPR improves cerebral and coronary perfusion and increases the chance of neurologically intact survival. However, CPR often must be paused for defibrillation when the patient is in ventricular tachycardia or ventricular fibrillation. Previous studies have suggested that using electrical insulating barriers during CPR may allow for hands-on defibrillation and reduce interruptions in compressions. But what does the best current evidence say about this important topic?
All hands on deck for hands-on defibrillation!
This was a Best Evidence Topic report composed of a review of 6 studies performed since 2000 examining hands-on defibrillation. In total, 721 biphasic shocks were delivered ranging from 30 J to 360 J. No shocks were detected when the rescuers used polyethylene gloves, electrical safety gloves, a resuscitation blanket, firefighter gloves, or a mechanical compression device. In addition, none of the studies reported injuries when an insulating barrier was used for hands-on defibrillation. Rescuers using bare hands, nitrile gloves, and neoprene pads did have perceptible shocks during hands-on defibrillation. Please note, these studies did not address how wet or rainy conditions, or the physical stress of compressions affected the insulating barriers.
This best evidence review suggests that hands-on defibrillation is safe with the use of appropriate insulating barriers. However, additional real-world studies assessing safety and efficacy are needed before hands-on defibrillation becomes standard of care. Nevertheless, 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.
BET 1: Can hands-on defibrillation be performed safely? Emerg Med J. 2020 Sep;37(9):585-586. doi: 10.1136/emermed-2020-210497.2.
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