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Accidental shock to rescuer from an implantable cardioverter defibrillator
Resuscitation 80 (2009) 293–294
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Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Images in resuscitation
Accidental shock to rescuer from an implantable cardioverter defibrillator Eftychios Siniorakis a , Georgia Hardavella b,∗ , Spyros Arvanitakis a , Georgia Roulia a , Petros Voutas a , Costas Karidis a a b
Department of Cardiology, Sotiria Chest Diseases Hospital, Athens, Greece 1stRespiratory Medicine Department, Medical School, Athens University, Athens, Greece
a r t i c l e
i n f o
Article history: Received 9 October 2008 Received in revised form 21 October 2008 Accepted 27 October 2008
Figure 1.
Figure 2.
∗ Corresponding author. E-mail address: [email protected] (G. Hardavella). 0300-9572/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2008.10.032
294
E. Siniorakis et al. / Resuscitation 80 (2009) 293–294
Figure 3.
A 74-year-old patient with heart failure and pneumonia had a cardiac arrest with an initial rhythm of pulseless electrical activity. He had a surgical scar in the left subclavian area suggesting he had a pacemaker. The patient’s electrocardiogram (ECG) showed a paced rhythm. Cardiopulmonary resuscitation (CPR) was started immediately. Ten minutes after starting CPR, the rescuer (not wearing gloves) who was doing chest compressions received an electric shock that threw him backwards and caused neck and back pain. The pacemaker identity card revealed that it was actually an implantable cardioverter defibrillator (ICD) and the shock was caused by the ICD discharging. An ICD programmer was not available to switch the ICD off. The patient’s ICD discharged a total of five times during the resuscitation attempt and before death was certified. When the device was finally switched off, its memory card was interrogated. The first shock of 21.9 J affecting the rescuer was triggered by chest compression-related muscular noise (Fig. 1). This was mistaken by the ICD as ventricular fibrillation (Fig. 2). One of the discharges appeared to be synchronous to interference from the mechanical ventilator (Fig. 3). Finally, while the surface ECG
displayed pacing spikes with an isoelectric line, the intracardiac ECG showed persistent electrical activity mimicking ventricular fibrillation. The exact incidence of ICD-related electrical shocks to rescuers during CPR remains unknown. A previous incident of an electrical shock affecting the rescuer was published in 2003.1 There should be a warning from ICD manufacturers about the risks of shocks from ICDs during CPR.2 How to safely treat a cardiac arrest in a patient with an ICD should be addressed in future resuscitation guidelines. Conflict of interest None to declare. References 1. Clements PA. Hazards of performing chest compressions in collapsed patients with internal cardioverter defibrillators. Emerg Med J 2003;20:379–80. 2. Nimawo S, Kojima J, Inuo U, et al. Measurement of body surface energy leakage of defibrillation shock by an implantable cardioverter defibrillator. PACE 2002;25:1212–8.
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Images in resuscitation
Accidental shock to rescuer from an implantable cardioverter defibrillator Eftychios Siniorakis a , Georgia Hardavella b,∗ , Spyros Arvanitakis a , Georgia Roulia a , Petros Voutas a , Costas Karidis a a b
Department of Cardiology, Sotiria Chest Diseases Hospital, Athens, Greece 1stRespiratory Medicine Department, Medical School, Athens University, Athens, Greece
a r t i c l e
i n f o
Article history: Received 9 October 2008 Received in revised form 21 October 2008 Accepted 27 October 2008
Figure 1.
Figure 2.
∗ Corresponding author. E-mail address: [email protected] (G. Hardavella). 0300-9572/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2008.10.032
294
E. Siniorakis et al. / Resuscitation 80 (2009) 293–294
Figure 3.
A 74-year-old patient with heart failure and pneumonia had a cardiac arrest with an initial rhythm of pulseless electrical activity. He had a surgical scar in the left subclavian area suggesting he had a pacemaker. The patient’s electrocardiogram (ECG) showed a paced rhythm. Cardiopulmonary resuscitation (CPR) was started immediately. Ten minutes after starting CPR, the rescuer (not wearing gloves) who was doing chest compressions received an electric shock that threw him backwards and caused neck and back pain. The pacemaker identity card revealed that it was actually an implantable cardioverter defibrillator (ICD) and the shock was caused by the ICD discharging. An ICD programmer was not available to switch the ICD off. The patient’s ICD discharged a total of five times during the resuscitation attempt and before death was certified. When the device was finally switched off, its memory card was interrogated. The first shock of 21.9 J affecting the rescuer was triggered by chest compression-related muscular noise (Fig. 1). This was mistaken by the ICD as ventricular fibrillation (Fig. 2). One of the discharges appeared to be synchronous to interference from the mechanical ventilator (Fig. 3). Finally, while the surface ECG
displayed pacing spikes with an isoelectric line, the intracardiac ECG showed persistent electrical activity mimicking ventricular fibrillation. The exact incidence of ICD-related electrical shocks to rescuers during CPR remains unknown. A previous incident of an electrical shock affecting the rescuer was published in 2003.1 There should be a warning from ICD manufacturers about the risks of shocks from ICDs during CPR.2 How to safely treat a cardiac arrest in a patient with an ICD should be addressed in future resuscitation guidelines. Conflict of interest None to declare. References 1. Clements PA. Hazards of performing chest compressions in collapsed patients with internal cardioverter defibrillators. Emerg Med J 2003;20:379–80. 2. Nimawo S, Kojima J, Inuo U, et al. Measurement of body surface energy leakage of defibrillation shock by an implantable cardioverter defibrillator. PACE 2002;25:1212–8.