Defibrillating Doctors Miss the Mark!

Early defibrillation is one of the few interventions proven to save lives. As with any procedure, correct anatomic placement is crucial. These British authors directly observed 101 physicians assigned to perform defibrillation on a manikin. The physicians were unaware of the nature of the study.

A grid placed over the chest wall was used to record paddle position. Only 65 percent of sternal paddles and 22 percent of apical paddles were placed within 5 cm of the positions recommended by the European Resuscitation Council guidelines. Most apical paddles were placed too medially and too cranially. No differences in placement were detected between physicians of different grades or specialties or between those who had or had not received defibrillation training within 3 years. The authors note that new guidelines promulgated shortly after the study was completed recommend even more lateral placement of the apical paddles (consistent with the recommendations of the American Heart Association). They conclude that greater emphasis on paddle placement during advanced cardiac life support training is needed.

Comment: Incorrect paddle placement could lead to unsuccessful defibrillation due to inadequate current passing through the myocardium, with the resultant risk of nondepolarization of critical areas of the heart. This small study does not prove much, but it does point out that we cannot take for granted the optimal performance of this critical intervention.

— KL Koenig

Published in Journal Watch Cardiology July 20, 2001
Originally published in Journal Watch Emergency Medicine July 5, 2001

Source

Heames RM et al. Do doctors position defibrillation paddles correctly? Observational study. BMJ 2001 Jun 9 322 1393-1394.