Hands-On Defibrillation: If the Glove Fits…You Must Acquit!

We’ve had some heated debates on the topic of hands-on defibrillation (HOD) for the past few years. We all know the most important time to avoid a pause during CPR is the perishock pause ([1]). We also know that despite lots of safety data ([2], [3]) and safe experience doing HOD ([4]) there are still concerns over the potential electrical leak using common exam gloves ([5], [6], [7], [8], [9]). For those who don’t enjoy a little electrical spice in your resuscitations, some recent articles have shown ways in which the safety of HOD can be mitigated using inexpensive tools.

Protective Equipment Makes Hands-On Defibrillation Safe

Yu and colleagues [10] used a resuscitation blanket in an animal model of 15 pigs to demonstrate the protection from electrical current during the HOD time. The resuscitation blanket is made from light weight insulating materials which have stable physical characteristics, such as high dielectric strength and outstanding resistance to flame. Even at levels of 360J (well beyond what most use) it was deemed to protect providers against dangerous levels of electricity.

Just recently, Deakin and colleagues [11] did a study, taking patients requiring elective cardioversion and performed 82 hands on cardioversions wearing Class I electrical gloves similar to that worn by professional electricians. They used a scale to ensure 20kg of pressure on the chest and had the pads placed in an anterior posterior placement. They placed electrodes on the chest near the pads and then attached them to the provider with a resistor to measure the possible scenario of a patient/provider contact during cardioversion. The peak levels of energy transfer fell well below the industry safety standard of 1 milliamp. The conclusion of the author and this reviewer is that there should be no reason we should need to pause compressions for defibrillation when wearing the proper protective equipment. Go get your gloves on!

Clinical Bottom Line: The resuscitation blanket or Class I electrical gloves are potentially safe and useful tools which protect the rescuer from hands-on defibrillation shocks, allowing for uninterrupted chest compressions, and therefore improving defibrillation success.

References:

1. Cheskes S et al. Perishock Pause: An Independent Predictor of Survival from Out-of-Hospital Shockable Cardiac Arrest. Circulation 2011. PMID: 21690495
2. Gibbs W et al. Dangers of Defibrillation: Injuries to Emergency Personnel During Patient Resuscitation. Am J Emerg Med 1990. PMID: 2302275
3. Hoke RS et al. Is External Defibrillation an Electric Threat for Bystanders? Resus 2009. PMID: 19211180
4. Lloyd MS et al. Hands-On Defibrillation: An Analysis of Electrical Current Flow through Rescuers in Direct contact with Patients During Biphasic External Defibrillation. Circulation 2008. PMID: 18458166
5. Sullivan JL et al. Will Medical Examination Gloves Protect Rescuers from Defibrillation Voltages During Hands-On Defibrillation? Resuscitation 2012. PMID: 22925991
6. Deakin CD et al. Do Clinical Examination Gloves Provide Adequate Electrical Insulation for Safe Hands-On Defibrillation? I: Resistive Properties of Nitrile Gloves. Resuscitation 2013. PMID: 23507464
7. Petley GW et al. Do Clinical Examination Gloves Provide Adequate Electrical Insulation for Safe Hands-On Defibrillation? II: Material Integrity Following Exposure to Defibrillation Waveforms. Resuscitation 2013. PMID: 23507465
8. Weingart SD. A Note of caution on the Performance of Hands-On Biphasic Defibrillation. Resuscitation 2013. PMID: 23266533
9. Lemkin DL et al. Electrical Exposure Risk Associated with Hands-On Defibrillation. Resuscitation 2014. PMID: 24992873
10. Yu T et al. The Resuscitation Blanket: A Useful Tool for “Hands-On” Defibrillation. Resuscitation 2010. PMID: 19962817
11. Deakin CD et al. Achieving Safe Hands-On Defibrillation Using Electrical Safety Gloves–A Clinical Evaluation. Resuscitation 2015. PMID: 25725295

Post Peer Reviewed by: Salim Rezaie (Twitter: @srrezaie)

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