Elsevier

Resuscitation

Volume 80, Issue 4, April 2009, Pages 395-401
Resuscitation

Review article
Is external defibrillation an electric threat for bystanders?

https://doi.org/10.1016/j.resuscitation.2009.01.002Get rights and content

Abstract

Background

Safety precautions during defibrillation and cardioversion are generally taken very seriously. The actual hazard for bystanders and rescuers, however, has rarely been investigated. Recently, continuing chest compressions during defibrillation has been suggested to improve outcome from cardiac arrest. This article is to review reports on electric shocks to persons other than patients and to discuss the pertinent biomedical principles.

Methods

Systematic search in medical literature databases and consecutive hand-search of reference lists.

Results

A total of 29 adverse events are reported in the medical literature; seven due to accidental or intentional defibrillator misuse, three due to device malfunction, four during training/maintenance procedures, and 15 during regular resuscitation efforts. Tingling sensations and minor burns are frequently reported consequences of inadvertent shocks. There are no accounts on immediate life-threatening conditions or long-term disability in rescuers/bystanders inflicted by defibrillation/cardioversion of a patient. Discharging a defibrillator directly to a healthy person's chest can be lethal.

Conclusions

External electric therapy is likely to be safer than traditionally assumed, especially with self-adhesive thoracic electrodes. Sound clinical experiments are urgently needed before safety measures are revised.

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.

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