Delays in defibrillation : influence of different monitoring techniques

Background. Rapid defibrillation is the most important intervention required for a patient in cardiac arrest due to ventricular fibrillation or ventricular tachycardia. Isolated case reports of spurious asystole may have seen a change in practice, moving away from monitoring through defibrillator paddles and gel pads in favour of attaching electrocardiograph (ECG) leads for the initial monitoring of a collapsed patient. We surveyed current preferences for initial monitoring and estimated the difference in time taken to deliver the first shock with the following three monitoring techniques: defibrillator paddles and gel pads, ECG leads and hands-free adhesive pads. Methods. Sixty Advanced Life Support (ALS) course directors, selected at random, were questioned to establish their current practice. Twenty ALS providers received 5 min revision in the three techniques for the initial monitoring of a collapsed patient and were then randomly tested to measure the time from confirmation of arrest to the first shock. Results. Forty-two directors indicated their preferred methods for initial monitoring as 74% leads, 21% paddles and 5% hands-free adhesive pads. Before testing, 10 providers preferred paddles and 10 preferred leads. Monitoring through leads 54 (range 49-65) s was significantly slower than paddles 28 (24-31) s, P<0.01 and adhesive pads 23 (19-27) s, P