Daniel L Lemkin1, Michael D Witting2, Michael G Allison3, Ali Farzad2, Michael C Bond2, Mark A Lemkin4. 1. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: dlemkin@em.umaryland.edu. 2. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. 3. Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, United States. 4. Linear Technology, Hayward, CA, United States.
Abstract
BACKGROUND: The use of hands-on defibrillation (HOD) to reduce interruption of chest compression after cardiac arrest has been suggested as a means of improving resuscitation outcomes. The potential dangers of this strategy in regard to exposing rescuers to electrical energy are still being debated. This study seeks to determine the plausible worst-case energy-transfer scenario that rescuers might encounter while performing routine resuscitative measures. METHODS: Six cadavers were acquired and prepared for defibrillation. A custom instrumentation-amplifier circuit was built to measure differential voltages at various points on the bodies. Several skin preparations were used to determine the effects of contact resistance on our voltage measurements. Resistance and exposure voltage data were acquired for a representative number of anatomic landmarks and were used to map rescuers' voltage exposure. A formula for rescuer-received dose (RRD) was derived to represent the proportion of energy the rescuer could receive from a shock delivered to a patient. We used cadaver measurements to estimate a range of RRD. RESULTS: Defibrillation resulted in rescuer exposure voltages ranging from 827V to ∼200V, depending on cadaver and anatomic location. The RRD under the test scenarios ranged from 1 to 8J, which is in excess of accepted energy exposure levels. CONCLUSIONS: HOD using currently available personal protective equipment and resuscitative procedures poses a risk to rescuers. The process should be considered potentially dangerous until equipment and techniques that will protect rescuers are developed.
BACKGROUND: The use of hands-on defibrillation (HOD) to reduce interruption of chest compression after cardiac arrest has been suggested as a means of improving resuscitation outcomes. The potential dangers of this strategy in regard to exposing rescuers to electrical energy are still being debated. This study seeks to determine the plausible worst-case energy-transfer scenario that rescuers might encounter while performing routine resuscitative measures. METHODS: Six cadavers were acquired and prepared for defibrillation. A custom instrumentation-amplifier circuit was built to measure differential voltages at various points on the bodies. Several skin preparations were used to determine the effects of contact resistance on our voltage measurements. Resistance and exposure voltage data were acquired for a representative number of anatomic landmarks and were used to map rescuers' voltage exposure. A formula for rescuer-received dose (RRD) was derived to represent the proportion of energy the rescuer could receive from a shock delivered to a patient. We used cadaver measurements to estimate a range of RRD. RESULTS: Defibrillation resulted in rescuer exposure voltages ranging from 827V to ∼200V, depending on cadaver and anatomic location. The RRD under the test scenarios ranged from 1 to 8J, which is in excess of accepted energy exposure levels. CONCLUSIONS: HOD using currently available personal protective equipment and resuscitative procedures poses a risk to rescuers. The process should be considered potentially dangerous until equipment and techniques that will protect rescuers are developed.
Authors: Jochen Hinkelbein; Steffen Kerkhoff; Christoph Adler; Anton Ahlbäck; Stefan Braunecker; Daniel Burgard; Fabrizio Cirillo; Edoardo De Robertis; Eckard Glaser; Theresa K Haidl; Pete Hodkinson; Ivan Zefiro Iovino; Stefanie Jansen; Kolaparambil Varghese Lydia Johnson; Saskia Jünger; Matthieu Komorowski; Marion Leary; Christina Mackaill; Alexander Nagrebetsky; Christopher Neuhaus; Lucas Rehnberg; Giovanni Marco Romano; Thais Russomano; Jan Schmitz; Oliver Spelten; Clément Starck; Seamus Thierry; Rochelle Velho; Tobias Warnecke Journal: Scand J Trauma Resusc Emerg Med Date: 2020-11-02 Impact factor: 2.953