18th Spring Meeting of the Association of Cardiothoracic Anaesthetists
- Meeting abstract
- Open Access
What is the optimal paddle force for defibrillation?
Critical Care volume 5, Article number: 4 (2001)
Firm paddle pressure during defibrillation is important to minimize transthoracic impedance (TTI) and optimize trans-myocardial current. Previous European Resuscitation Council (ERC) guidelines recommended that 12 kg force should be used  and the more recent International Liaison Committee on Resuscitation (ILCOR) guidelines recommend 'firm' pressure . The actual relationship between force and transthoracic impedance has not been established.
55 patients (36 male, 19 female) undergoing general anaesthesia for cardiac surgery were investigated. Male chests were shaved. A pair of gel pads and paddles were placed in the anterior-apical position according to the ILCOR guidelines. The endotracheal tube was opened to air and paddles instrumented with force sensors were applied to the chest wall with progressive force to a maximum of 12 kgf. The resultant TTI was recorded at 10 measurements per second to a hard drive.
Light pressure results in a high TTI that rapidly decreases as paddle force increases (Fig. 1). An 18.7% fall in overall TTI occurs when applying force from 0.5 to 6.0 kg. Increasing paddle force from 6 to 12 kg results in a further decrease in TTI of 3.2%.
A minimum of 6 kg force applied to each paddle is necessary to achieve 83% of the overall decrease in TTI seen at 12 kgf. Further decrease in TTI as force is applied in excess of 6 kgf is small and a force of 12 kgf only reduces TTI by a further 3.2% compared with TTI at 6 kgf. The additional clinical benefit of applying 12 kgf as opposed to 6 kgf is questionable.
Robertson C, et al.: Resuscitation 1998, 37: 81. 10.1016/S0300-9572(98)00035-5
Deakin C, Petley G, Cardan E, Clewlow F: Does paddle force applied during defibrillation meet advanced life support guidelines of the European Resuscitation Council? Resuscitation 2001, 48: 301-303. 10.1016/S0300-9572(00)00265-3
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Deakin, C., Sado, D., Petley, G. et al. What is the optimal paddle force for defibrillation?. Crit Care 5, 4 (2001). https://doi.org/10.1186/cc1033
- General Anaesthesia
- Emergency Medicine
- Clinical Benefit
- Chest Wall
- Endotracheal Tube