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Related Concept Videos

Cardiopulmonary Resuscitation III: AED Use01:23

Cardiopulmonary Resuscitation III: AED Use

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Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
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Cardiopulmonary Resuscitation I: Adult01:21

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Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
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Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
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Electrocardiogram Fundamentals01:28

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Introduction
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Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

Cardiopulmonary Resuscitation II: ACLS Airway Management

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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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Assessing the Apical Pulse
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Related Experiment Video

Updated: Sep 13, 2025

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Pad size, orientation, and placement for defibrillation during basic life support: A systematic review.

Giuseppe Ristagno1,2, Federico Semeraro3, Violetta Raffay4

  • 1Department of Pathophysiology and Transplantation, University of Milan, Italy.

Resuscitation Plus
|July 31, 2025
PubMed
Summary

Defibrillation pad size and orientation show no clear benefit for cardiac arrest survival. Anterior-posterior pad placement may improve outcomes in refractory ventricular fibrillation, but more research is needed.

Keywords:
Anterior-lateralAnterior-posteriorDefibrillationOutcomePads positionVector

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Research

Background:

  • Defibrillation is critical for treating shockable cardiac arrest.
  • Optimal defibrillation pad parameters (size, orientation, position) are not well-established.
  • Current evidence on pad characteristics' impact on clinical outcomes is limited.

Purpose of the Study:

  • To systematically review evidence on defibrillation pad size, orientation, and position.
  • To evaluate their impact on clinical outcomes in adult and pediatric cardiac arrest with a shockable rhythm.

Main Methods:

  • Systematic review registered with PROSPERO (CRD42024512443).
  • Searches of PubMed, EMBASE, and Cochrane Library up to March 31st, 2025.
  • Inclusion of studies comparing pad sizes or positions in adult/pediatric cardiac arrest.
  • Risk of bias assessment (RoB 2.0, ROBINS-I) and certainty of evidence evaluation (GRADE).

Main Results:

  • Four studies (1 RCT, 3 observational) including 1334 adult patients met criteria.
  • Pad size evidence was sparse; no significant difference in defibrillation success between large and small pads.
  • No evidence found for pad orientation.
  • Anterior-posterior (AP) pad placement suggested potential survival benefit in refractory ventricular fibrillation (VF) compared to anterior-lateral (AL) placement (adj. RR 1.71[1.01-2.88]).
  • Observational data on pad placement were conflicting and high risk of bias.

Conclusions:

  • Current evidence is inconclusive regarding the superiority of specific pad sizes, orientations, or positions for cardiac arrest survival.
  • Vector-change to AP pad placement may benefit refractory VF cases.
  • High-quality randomized clinical trials are necessary to guide clinical practice.