Written by Millie Cossé
Spoon Feed
Anterior-posterior (AP) pad position is associated with return of spontaneous circulation (ROSC) in patients with out-of-hospital ventricular fibrillation cardiac arrest.
Charging… CLEAR!
This secondary analysis of the DOSE VF RCT examined whether variations in transthoracic shock current are associated with improvement in ROSC and whether changes in pad position were associated with ROSC.
The authors found that anterior-posterior (AP) shocks had significantly greater mean current (amps) and significantly lower impedance (Ω) compared with anterolateral (AL) pad placement. AP pad position was also significantly associated with ROSC (aOR 2.68, 95%CI 1.00–7.20).
It is important to remember that the protocol for DOSE VF had all patients receive at least 3 shocks in the AL position prior to being randomized to vector change (AP) or dual-sequence external defibrillation.
How will this change my practice?
Whenever possible, I try to place pads in the AP position for coding patients. It makes sense to imagine the vector through which we are trying to depolarize the myocardium, and there have been other studies that suggest a benefit. Ultimately, a randomized AL vs. AP pad placement study is needed.
Source
The impact of defibrillation current and pad position on return of spontaneous circulation during refractory ventricular fibrillation. Resuscitation. 2026 May;222:111061. doi: 10.1016/j.resuscitation.2026.111061. Epub 2026 Mar 17. PMID: 41856454.
