Posted on 07/21/2014

NEW YORK, NY-- Rescuers who perform chest compressions at the same time that another uses a defibrillator may be at risk of electric shock, a new study suggests.

In a trial with cadavers, so-called hands-on defibrillation exposed rescuers to 200 to 827 volts, or 1 to 8 joules, which is more than safety standards recommend.

"The rescuer energy we measured (1 to 8 J) is not dramatically high, but it shares a waveform and frequency designed to affect cardiac myocytes. In susceptible rescuers, this could result in serious injury," Dr. Daniel Lemkin, an emergency medical physician at the University of Maryland School of Medicine in Baltimore, Maryland, who led the study, told Reuters Health by email.

Instead, Dr. Lemkin and his colleagues advise rescuers to perform compressions while the defibrillator charges, remove their hands during defibrillation, and then resume immediately afterward.

The researchers published their findings on June 30 online ahead of print in Resuscitation.

The American Heart Association supports their advice. Its 2010 guidelines suggest "efficient coordination between CPR and defibrillation" to shorten the delay in chest compressions. But it does not suggest hands-on defibrillation.

The literature seems to show that minimizing interruptions in chest compressions can benefit the patient. But there is apparently little evidence for the benefit of entirely uninterrupted compressions, which hands-on defibrillation attempts to provide.

Dr. Lemkin and his team did not find any randomized controlled trials of the practice in people. The research they did find was in animals and, in at least one study, the emergency personnel wore medical gloves.

The gloves may present a problem, the researchers write. Gloves can tear or wear out. And even when intact, not all types of gloves provide the same protection against electricity. And, of course, not all rescue personnel wear gloves when they deliver chest compressions.

"Our concern is that if (hands-on defibrillation) is routinely performed, the number of risk exposures will increase dramatically, as will the potential for rescuer injury," Dr. Lemkin said.

Hands-on defibrillation may become routine in the future, but not before the risk is managed.

"Until personal protective equipment exists which is designed to mitigate the risk to rescuers from inadvertent electrical exposure, the procedure should be considered potentially dangerous," Dr. Lemkin said.

SOURCE: Reuters Health

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