Ex vivo evaluation of personal protective equipment in hands-on defibrillation

Defibrillation guidelines recommend avoiding patient contact during shock delivery. However, hands-on defibrillation (compressions during shock) and manual pressure augmentation (MPA - pushing on the defibrillator pads during shock) may lead to improved clinical outcomes. There are limited data addressing the protection provided by personal protective equipment (PPE) during hands-on defibrillation and MPA. This study investigated the hand-to-hand and hand-to-knee leakage current experienced by a simulated kneeling provider wearing different PPE.

A defibrillator was used in experiments on a pork shoulder, investigating three different hands-on positions: closed fist on defibrillator pads; open palm on pads with inadvertent finger contact (overhang); and open palm on the chest. Evaluated PPE included single and double gloves (nitrile and latex) and rescuer cargo trousers in wet and dry conditions (N = 126 experiments).

Mean hand-to-hand leakage currents in MPA without PPE was 0.41 mA (0.2-0.74 mA) and with PPE was 0.2 mA (0.08-0.58 mA). For experiments involving finger or palm contact on the chest, wearing any PPE resulted in a >99% reduction in mean leakage currents from an average 354.58 mA (258.96-446.22 mA) to an average 0.48 mA (0.16-1.56 mA). Rescuer trousers were insulative in dry conditions even without gloves (0.2-1.2 mA).

This study demonstrated that the tested clinical examination gloves markedly reduced leakage current to the rescuer and that the lowest levels of leakage current occurred during MPA attributed to the electrical insulation of the pads.