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.