Are European Resuscitation Council recommendations for paddle force achievable during defibrillation?

Area of Science:

• Cardiology
• Emergency Medicine
• Medical Devices

Background:

• Transthoracic impedance (TTI) significantly impacts defibrillation success by influencing transmyocardial current.
• Optimal TTI is achieved by minimizing paddle-skin interface impedance, primarily through applied paddle pressure.
• Current guidelines offer varying recommendations on the force required for defibrillation paddles.

Purpose of the Study:

• To evaluate the ability of advanced life support-trained professionals to achieve the recommended 12 kg paddle force.
• To identify factors influencing the application of adequate force during defibrillation simulations.

Main Methods:

• Fifty doctors and nurses trained in advanced life support simulated defibrillation on a resuscitation doll.
• Participants attempted to apply 12 kg of force to both defibrillation paddles.
• Maximum achievable paddle force was measured, with analysis of correlations to operator characteristics.

Main Results:

• The median maximum force achieved was 10.1 kg, with only 14% of operators reaching or exceeding 12 kg on both paddles.
• Men applied significantly more force than women (10.7 vs. 8.1 kg).
• Force correlated with operator height and dominant hand-grip strength.

Conclusions:

• The European Resuscitation Council's recommendation of 12 kg paddle force is not consistently achievable by most defibrillator operators.
• Deficiencies in achieving adequate paddle force may compromise defibrillation efficacy.
• Further research may be needed to refine defibrillation force guidelines or develop alternative methods to ensure optimal transthoracic impedance.