A case of dextrocardiac ventricular fibrillation arrest

Successful defibrillation of a patient with dextrocardia using conventional anterolateral paddle positions raises doubts about the necessity to place paddles in the exact recommended positions. Evidence found relates either to volunteers in a laboratory setting or to defibrillation of atrial arrhythmias. The conclusion is that there is no published difference either in transthoracic impedance or in success of defibrillation between anteroposterior and anterolateral paddle positions. In the absence of any evidence for an ideal apical paddle position in the standard anterolateral defibrillation of ventricular arrhythmias, the emphasis in ALS and resuscitation guidelines on "correct" positioning seems misplaced, and, by adding unnecessary information, may hinder learning the skill of defibrillation. Early defibrillation is crucial to successful recovery from cardiac arrest and anything that delays cardioversion should be avoided. The limited evidence suggests that the exact position of the paddles does not matter. The time taken to find the "correct" position is time wasted and it may instead be preferable to teach people merely to place the apical paddle to the left of the nipple in the midaxillary line.