Review articleIs external defibrillation an electric threat for bystanders?☆
Introduction
External defibrillation constitutes a cornerstone of modern resuscitation medicine. It is routine for healthcare professionals, and, more recently, the use of defibrillators by lay people is strongly advocated and progressively implemented. Course manuals have always highlighted the potential hazard of defibrillation to rescuers and bystanders, and course instructors usually emphasize the importance of a safe defibrillation technique to avoid anticipated complications.1 However, evidence is scarce in relation to such complications, and advocated safety precautions for electrical therapy are so far based on common sense or anecdotal reports of adverse events. Efforts to stay clear of the patient during charging and discharging increase hands-off intervals during cardiopulmonary resuscitation which have proven detrimental.2, 3, 4, 5, 6 Advances in signal filtering technology may allow automated rhythm analysis during uninterrupted chest compression in the future.7, 8 Better understanding of actual hazards of defibrillation will allow for the development of prudent risk-adjusted safety rules that facilitate minimizing pauses in chest compressions. This article reviews reports on electric shocks from defibrillator use to persons other than patients and discusses the pertinent biomedical principles.
Section snippets
Methods
The databases MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for articles in English, German or French through 1 May 2008 using the following search terms (in singular and plural where appropriate) confined to title words: (defibrillat* OR “electric* shock” OR countershock OR cardioversion) AND (danger OR hazard OR harm OR risk OR complication OR adverse OR injury OR fatal OR lethal OR accidental OR injury OR spark OR oxygen OR safety OR security OR precautions).
Results
Inadvertent electric shocks have been described in four principal situations: defibrillator misuse, faulty equipment, training/maintenance procedures, and regular resuscitations. Seven reports on intentional or accidental defibrillator misuse were identified that occurred off any regular medical procedure (Table 1). Of these, one full capacity shock to the chest apparently caused a life-threatening arrhythmia and resuscitation efforts were unsuccessful eventually. In the remaining six incidents
Discussion and review
From the outset of modern defibrillation common sense has dictated not to be in direct or indirect contact with a patient during electrical therapy. Safety precautions advocated by medical authorities and manufacturers to prevent electrical accidents include standard device maintenance procedures, avoidance of excessive amounts of conduction gel during resuscitation, preferential use of gel pads, giving announcements aloud, checking that everybody stands clear before defibrillator discharge,
Conclusions
Evident in the medical literature, to the best of our knowledge, no rescuer or bystander has ever been seriously harmed by receiving an inadvertent shock while in direct or indirect contact with a patient during defibrillation. New evidence suggests that it might even be electrically safe for the rescuer to continue chest compressions during defibrillation if self-adhesive defibrillation electrodes are used and examination gloves are worn. According to recent data a continuous compression
Conflict of interest
None declared.
Acknowledgement
The authors are grateful for graphical assistance provided by Stefan Schulze.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.01.002.