Removal of bra for pad placement and defibrillation - A scoping review

In some regions, females are less likely to receive public-initiated resuscitation, potentially due to the need to expose the chest and breasts for proper automated external defibrillator (AED) pad placement. We conducted a scoping review to investigate the breadth of the existing literature and knowledge gaps on bra (brassière) removal and AED pad application.

Studies that examined bra removal and outcomes associated with AED pad placement and defibrillation in cardiac arrest were eligible. We searched three databases (Medline, Embase, and Cochrane) from inception to September 26, 2024. Google and Google Scholar (first 20 pages) were searched for grey literature on October 1, 2024. The study followed the scoping review framework by the Joanna Briggs Institute.

The search identified 287 references. Three studies met the eligibility criteria, including one animal and two manikin studies, of which two were conference abstracts. No studies examined patient outcomes. No adverse events were reported with defibrillation in a pig model with AED pads in direct contact with a bra's underwire. No difference in time to pad placement or shock delivery was seen with bra removal in simulation. One simulation study reported female manikins were less likely to be completely de-robed, including bra removal, which was attributed to social norms, modesty, and lack of awareness.

Scant evidence is available on the need for bra removal and outcomes associated with AED application. Further research is needed to explore whether bra removal is imperative for AED pad placement and defibrillation.