Abstract 12235: A Randomized Control Hands-on Defibrillation Study - Barrier Use Evaluation

Introduction: Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time (pre-shock pause) results in a zero blood flow state. Pre-shock pause has been associated with poorer neurological recovery from cardiac arrest. Methods: This was a blinded randomized control cadaver study evaluating a rescuer’s ability to detect defibrillation during manual chest compressions. We used two defibrillators, with identical auditory signals during charging, and shock delivery. The active defibrillator was connected to the cadaver in the sternum-apex configuration with self-adhesive defibrillation pads. The sham defibrillator was connected to a device designed to safely and silently receive current. After informed consent, paramedic subjects performed chest compressions on the cadaver using 6 types of hand barriers: no-barrier, single and double layer nitrile gloves, firefighter gloves, neoprene pad, and a manual chest compression/decompression device. Randomized defibrillations (10 per barrier type) were delivered at 30 joules (J) for bare hand and 360J for all other barriers. After each shock, the subject indicated degree of sensation on a Likert scale. Results: Ten subjects participated and utilized six barrier methods. Half of the shocks were randomized to sham. All subjects detected 30j shocks during barehand compressions, with only 1 undetected real shock, and no reports of feeling a bare-handed sham shock. All barriers combined totaled 500 shocks delivered. Five (1%) active shocks were detected with any barrier, 1 (0.2%) with single layer of Nitrile gloves, 3 (0.6%) with double layer nitrile-gloves and 1 (0.2%) with the neoprene barrier. One sham shock was reported detected with the single layer nitrile glove. No shocks were detected with fire gloves or compression decompression device. Subjects reported all shocks detected as barely perceptible (0.25 (±.05) cm on 10 cm Likert scale). Conclusions: Nitrile gloves or a neoprene pad essentially prevent (99%) responder’s detection of a 360J defibrillation on a cadaver. Fire gloves and compression decompression device prevented detection.