Hands on defibrillation: Even if it’s safe, would it actually help?

From First10 EM (Research Roundup)

Stephens AF, Šeman M, Nehme Z, Voskoboinik A, Smith K, Gregory SD, Stub D. Ex vivo evaluation of personal protective equipment in hands-on defibrillation. Resusc Plus. 2022 Aug 3;11:100284. doi: 10.1016/j.resplu.2022.100284. PMID: 35942482

Given the importance of limiting pauses in chest compressions, there has been interest (from some people) in performing hands on defibrillation. This study mostly gets included because self-experimentation (the authors put themselves at risk) is interesting. The study itself uses a pig model, and looks at 3 different scenarios: 1) adding pressure to the pads only, with a closed fist, as one might if trying to improve contact for cardioversion; 2) adding pressure over the pads, but with fingers on the skin, as if one made a mistake in scenario #1; 3) hands in the middle of the chest, on skin, as if doing chest compressions. In each setup, they tested multiple PPE options (different types of gloves, double gloving, etc.). There are lots of numbers in the paper. Shocking while doing chest compressions without gloves seems like a bad idea, as the measured current was potentially high enough to induce cardiac arrest. However, my best summary of all the numbers is that as long as you are wearing gloves, you won’t be exposed to 2 mA of current, and therefore would be well below the level of danger (but you might feel something). Whether all this effort is worth it is another question altogether. The papers I have seen on the topic have all focused on safety. Personally, I have some questions about efficacy. Chest compressions dramatically impact the anatomy of the chest, and often cause contact issues with pads, which seems like it could impact the vector and efficacy of defibrillation. I think we need to be questioning the efficacy of this approach, and not just its safety. If you need to stop compressions anyway to ensure efficacy, why not just raise your hands briefly off the chest? More than that, to ensure good compressions, we need to be swapping out compressors every 2 minutes, and defibrillation is a natural stop point. Why introduce another unnecessary pause? Personally, my guess is that latex gloves will be enough to keep us safe, but that the whole concept may be flawed and unnecessary. On the other hand, ‘manual compression augmentation’, when pressure is applied over the pads to ensure good contact and decrease impedance makes some sense to me. However, we already have a device specifically designed for this task – traditional paddles. If you need to improve contact, why not use the paddles, rather than your hands?

Bottom line: This data suggests that as long you are wearing gloves, hands on defibrillation is probably safe. However, I think we need to question its overall value before adopting such a practice.

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