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DO CLINICAL EXAMINATION GLOVES PROVIDE ADEQUATE ELECTRICAL INSULATION FOR SAFE HANDS-ON DEFIBRILLATION?
Oral Presentations / Resuscitation 83 (2012) e1–e23
total number of AEDs and lay rescuers in the system was 1210 and 12.253 respectively. Results: AEDs used by lay rescuers were connected in 95 of 692 cases. The median radius of the circle around the victims was 537 m. Median time from call to first shock was 7 min 42 s. In 19% of cases, the first shock was given <6 min. In 37% of 522 cases no AEDs were involved, in 32% 1-2, in 22% 3-4, in 5% 5-6, and in 3% > 6. When 0, 1-2, 3-4, 5-6 or >6 AEDs were involved, median time from call to first shock decreased from 10:30 (min:s) to 8:39, 7:39, 7:20 and 7:21 respectively. The percentage of patients receiving a first shock <6 min increased from 16%–11%, 24%, 25% and 33% respectively. Conclusion: To achieve >25% of shocks <6 min, at least 56 AEDs are needed in the circle. This corresponds with 6 AEDs km2 . Reference [1].Berdowski J, Blom MT, Bardai A, Tan HL, Tijssen JG, Koster RW. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation 2011;124:2225–32.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.033 AS029 DO CLINICAL EXAMINATION GLOVES PROVIDE ADEQUATE ELECTRICAL INSULATION FOR SAFE HANDS-ON DEFIBRILLATION? Victoria Lee-Shrewsbury ∗ , Kitwani Hogg, Graham Petley, Charles Deakin University Hospital Southampton, Southampton, UK Introduction: The quality of external chest compression during a resuscitation attempt is crucial to successful defibrillation and return of spontaneous circulation. Interruptions to chest compressions are often related to defibrillation as the rescuer stands clear for the rhythm check and subsequent shock delivery. The ability to continue chest compressions during defibrillation (handson defibrillation) would contribute significantly to minimising no flow time and improving the overall effectiveness of chest compressions. Several studies have suggested that clinical examination gloves provide adequate electrical insulation to enable hands-on defibrillation to be safely undertaken. Glove integrity however is often compromised during clinical procedures. We examined clinical examination gloves used for CPR to ascertain whether they offer sufficient protection to limit current to below the safe threshold of 1 mA. Methods: New nitrile gloves, and those used at cardiac arrests were collected. Electrical resistance was measured by first suspending the glove in a container and then filling both glove and container with saline. Copper electrodes were placed inside and outside the glove and electrical resistance measured using an AVO meter. Results: Ten control gloves and 84 gloves used at cardiac arrests (of which 57 were used clinically for chest compressions (CC)) were tested. Mean control resistance (±SD) was 191.1 (±25.1) k, mean CC resistance was 131.5 (±36.7) k, and mean nonCC resistance was 159.6 (±40.5) k. Compared with the control group, resistance was significantly lower in gloves used at cardiac arrests, both for chest compressions (P = 0.002; 95%CI between means 45.1–74.1 k) and not (P = 0.025; 95%CI between means 21.6–41.4 k). Conclusion: The electrical resistance of commonly used clinical examination gloves allows current flow >1 mA across the rescuer’s gloves during defibrillation. Gloves used clinically, particularly for chest compressions, degrade further and provide even
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less insulation. Nitrile gloves cannot be safely used for hands-on chest compressions. http://dx.doi.org/10.1016/j.resuscitation.2012.08.034 AS030 Postshock rhythm after first defibrillation of out-of-hospital cardiac arrest patients in ventricular fibrillation: An early outcome predictor Benno Wolcke ∗ , Nicole Didion, Carsten Lott, Holger Buggenhagen, Christian Werner, Hendrik Gervais Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany Background: Successful defibrillation is defined as termination of ventricular fibrillation (VF) 5 s after shock delivery, more precisely, the absence of VF or pulseless ventricular tachycardia (VT). Some investigations defined successful defibrillation as return of an organized rhythm within the first minute after shock. There is however no evidence that those definitions correlate with neurological intact survival. Therefore we retrospectively analyzed all automated external defibrillator uses of first tier ambulances in our region from a 9–year period. Methods: Postshock-rhythm 5 s after shock delivery as well as return of an organized rhythm during the first minute after shock were analyzed. Postshock-rhythm was graded in 3 categories: persisting VF, asystole or organized rhythm. Primary endpoint was good neurological outcome at hospital discharge. Results: After the first shock 89 patients had persisting VF/VT (32.1%), 151 an asystole (54.5%) and 37 an organized rhythm (13.4%). More patients with an organized rhythm directly (5 s) after the first shock had a good neurological outcome (VF 13.5%; asystole 12.6%; organized rhythm 37.8%; p = 0.001). However, the return of an organized rhythm during the first minute (OR1) after shock had no significant impact on the number of patients with good neurological outcome in our setting (OR1: 24.1%; no-OR1: 14.5%; p = 0.066). Conclusion: The return of an organized rhythm directly after defibrillation, but not the termination of VF in general predicted good neurological outcome. Further reading [1].Deakin C, Nolan J, Sunde K, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2010;81: 1293–304. [2].Schneider T, Martens P, Paschen H, et al. Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims. Circulation 2000;102:1780–7. [3].Van Alem A, Chapman F, Lank P, et al. A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in outof-hospital cardiac arrest. Resuscitation 2003;58:17–24.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.035
total number of AEDs and lay rescuers in the system was 1210 and 12.253 respectively. Results: AEDs used by lay rescuers were connected in 95 of 692 cases. The median radius of the circle around the victims was 537 m. Median time from call to first shock was 7 min 42 s. In 19% of cases, the first shock was given <6 min. In 37% of 522 cases no AEDs were involved, in 32% 1-2, in 22% 3-4, in 5% 5-6, and in 3% > 6. When 0, 1-2, 3-4, 5-6 or >6 AEDs were involved, median time from call to first shock decreased from 10:30 (min:s) to 8:39, 7:39, 7:20 and 7:21 respectively. The percentage of patients receiving a first shock <6 min increased from 16%–11%, 24%, 25% and 33% respectively. Conclusion: To achieve >25% of shocks <6 min, at least 56 AEDs are needed in the circle. This corresponds with 6 AEDs km2 . Reference [1].Berdowski J, Blom MT, Bardai A, Tan HL, Tijssen JG, Koster RW. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation 2011;124:2225–32.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.033 AS029 DO CLINICAL EXAMINATION GLOVES PROVIDE ADEQUATE ELECTRICAL INSULATION FOR SAFE HANDS-ON DEFIBRILLATION? Victoria Lee-Shrewsbury ∗ , Kitwani Hogg, Graham Petley, Charles Deakin University Hospital Southampton, Southampton, UK Introduction: The quality of external chest compression during a resuscitation attempt is crucial to successful defibrillation and return of spontaneous circulation. Interruptions to chest compressions are often related to defibrillation as the rescuer stands clear for the rhythm check and subsequent shock delivery. The ability to continue chest compressions during defibrillation (handson defibrillation) would contribute significantly to minimising no flow time and improving the overall effectiveness of chest compressions. Several studies have suggested that clinical examination gloves provide adequate electrical insulation to enable hands-on defibrillation to be safely undertaken. Glove integrity however is often compromised during clinical procedures. We examined clinical examination gloves used for CPR to ascertain whether they offer sufficient protection to limit current to below the safe threshold of 1 mA. Methods: New nitrile gloves, and those used at cardiac arrests were collected. Electrical resistance was measured by first suspending the glove in a container and then filling both glove and container with saline. Copper electrodes were placed inside and outside the glove and electrical resistance measured using an AVO meter. Results: Ten control gloves and 84 gloves used at cardiac arrests (of which 57 were used clinically for chest compressions (CC)) were tested. Mean control resistance (±SD) was 191.1 (±25.1) k, mean CC resistance was 131.5 (±36.7) k, and mean nonCC resistance was 159.6 (±40.5) k. Compared with the control group, resistance was significantly lower in gloves used at cardiac arrests, both for chest compressions (P = 0.002; 95%CI between means 45.1–74.1 k) and not (P = 0.025; 95%CI between means 21.6–41.4 k). Conclusion: The electrical resistance of commonly used clinical examination gloves allows current flow >1 mA across the rescuer’s gloves during defibrillation. Gloves used clinically, particularly for chest compressions, degrade further and provide even
e13
less insulation. Nitrile gloves cannot be safely used for hands-on chest compressions. http://dx.doi.org/10.1016/j.resuscitation.2012.08.034 AS030 Postshock rhythm after first defibrillation of out-of-hospital cardiac arrest patients in ventricular fibrillation: An early outcome predictor Benno Wolcke ∗ , Nicole Didion, Carsten Lott, Holger Buggenhagen, Christian Werner, Hendrik Gervais Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany Background: Successful defibrillation is defined as termination of ventricular fibrillation (VF) 5 s after shock delivery, more precisely, the absence of VF or pulseless ventricular tachycardia (VT). Some investigations defined successful defibrillation as return of an organized rhythm within the first minute after shock. There is however no evidence that those definitions correlate with neurological intact survival. Therefore we retrospectively analyzed all automated external defibrillator uses of first tier ambulances in our region from a 9–year period. Methods: Postshock-rhythm 5 s after shock delivery as well as return of an organized rhythm during the first minute after shock were analyzed. Postshock-rhythm was graded in 3 categories: persisting VF, asystole or organized rhythm. Primary endpoint was good neurological outcome at hospital discharge. Results: After the first shock 89 patients had persisting VF/VT (32.1%), 151 an asystole (54.5%) and 37 an organized rhythm (13.4%). More patients with an organized rhythm directly (5 s) after the first shock had a good neurological outcome (VF 13.5%; asystole 12.6%; organized rhythm 37.8%; p = 0.001). However, the return of an organized rhythm during the first minute (OR1) after shock had no significant impact on the number of patients with good neurological outcome in our setting (OR1: 24.1%; no-OR1: 14.5%; p = 0.066). Conclusion: The return of an organized rhythm directly after defibrillation, but not the termination of VF in general predicted good neurological outcome. Further reading [1].Deakin C, Nolan J, Sunde K, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation 2010;81: 1293–304. [2].Schneider T, Martens P, Paschen H, et al. Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims. Circulation 2000;102:1780–7. [3].Van Alem A, Chapman F, Lank P, et al. A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in outof-hospital cardiac arrest. Resuscitation 2003;58:17–24.
http://dx.doi.org/10.1016/j.resuscitation.2012.08.035