Changing Defibrillator Pad Placement Increases Survival by 164%

A recent trial has revealed that placing defibrillator pads in an anterior-posterior (AP) configuration—on the chest and back—can increase the odds of surviving an out-of-hospital cardiac arrest (OHCA) by more than two-and-a-half times compared to the traditional anterior-lateral (AL) positioning, where both pads are placed on the chest. These findings offer a significant advancement in improving the survival chances for patients experiencing shockable heart rhythms like ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

Improving Survival in OHCA

The survival rate for OHCA is low, with only 30% of cases seeing a return of spontaneous circulation (ROSC) and just 10% of patients surviving to hospital discharge. However, when a cardiac arrest is caused by a shockable rhythm, rapid defibrillation is critical in increasing the chances of survival. Defibrillation uses pads placed on the chest to deliver an electrical shock that restores the heart to a normal rhythm.

The conventional method involves placing one pad on the right side of the chest and the other on the lower left side. Researchers from Oregon Health and Science University (OHSU) examined whether switching to AP positioning, with one pad on the chest and the other on the back, could enhance outcomes.

Key Findings

The study analyzed data from 255 OHCA patients with shockable rhythms recorded between 2019 and 2023. Of these, 62% received defibrillation with AP pad placement, while 38% were treated with the standard AL configuration. The primary outcome was the return of spontaneous circulation (ROSC). Patients with AP placement had 2.64 times higher odds of achieving ROSC compared to those with AL positioning.

The researchers propose that the AP placement directs the electrical current more effectively through the heart, leading to better resuscitation outcomes. This “sandwiching” effect may be crucial in delivering a stronger, more focused electrical shock to the heart muscle, improving the chances of restoring a normal rhythm.

Сonclusion

The study’s findings suggest that reconsidering the standard defibrillator pad placement in OHCA cases could significantly improve early resuscitation success rates, especially for those experiencing shockable rhythms. Further research and training could potentially increase the use of AP placement in clinical settings, offering a relatively simple yet effective way to improve survival rates in cardiac emergencies.

With OHCA being one of the leading causes of death worldwide, this new insight into defibrillator pad placement provides a valuable opportunity to enhance resuscitation techniques and save more lives.