External defibrillation failure due to antimicrobial incise drape.

Area of Science:

• Medical Devices
• Cardiology
• Infection Control

Background:

• Antimicrobial incise drapes are used intraoperatively to prevent surgical site infections.
• High transthoracic impedance can impede effective external defibrillation.
• The interaction between incise drapes and defibrillation efficacy is not well-established.

Observation:

• A patient undergoing aortic valve replacement experienced ventricular fibrillation prior to sternotomy.
• Multiple external defibrillation attempts were unsuccessful with the antimicrobial incise drape in place.
• Successful defibrillation was achieved immediately after removing the incise drape.

Findings:

• This case suggests antimicrobial incise drapes can increase transthoracic impedance, potentially preventing defibrillation.
• This is the first reported instance of an antimicrobial incise drape interfering with external defibrillation.
• Increased impedance due to the drape likely hindered electrical current delivery.

Implications:

• Prompt removal of antimicrobial incise drapes is advised if intraoperative defibrillation, cardioversion, or pacing is required.
• Institutional protocols should consider pre-placement of defibrillator pads lateral to the surgical field.
• This highlights a potential safety concern with antimicrobial incise drapes in critical intraoperative scenarios.