Hands On defibrillation - HOD

HardKnocks

HardKnocks

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This Technique has been studied for over 20+yrs yet it fails to gain acceptance in U.S. EMS Protocols. Stats show that even a >10 second interruption of CPR during Cardiac Arrest significant affects blood flow, (i.e. decreased cardiac perfusion), and impacts/reduces the percentage of a patient's survival rate.

Real Time HOD in the ER

There are ab few studies were CPR Rescuers were hooked up to electrodes and Oscilloscopes while making contact to a simulated AED/Defibrillation. Most Rescuers reported feeling only slight tingling from the leaking voltage of the AED.

Other than vicarious liability of the slight chance of injury to a CPR Rescuer, what other negative do you see in HOD vs the potential gains in survivability for a Cardiac Arrest PT?

Btw, if you haven't seen Larry Mellick in action, he's produced hundreds of excellent Trauma training videos in his career as a ER Trauma Physician.
 
That’s why you pump until you hit the button, then start back up. Less than 5 seconds used.

So it’s ok to have hands on while delivering 360? You’ve done it then, right?
 
Old article on this, interesting reading. Some studies suggest two pairs of gloves are sufficient with bipahsic shocks. https://shortcoatsinem.blogspot.com/2012/10/double-gloving-it-hands-on.html

Precharging is great, but any pause is lowering/bottoming out the chest compression fraction and CPP. Combining this with the Zoll which can "see" the rhythm through compressions could result in zero pauses.
 
You know, I've heard that hands on defib has been doable for quiet a few years... which runs contrary to 30+ years of yelling "clear" before shocking.

most providers I know of are very hesitant to do hands on defib; even if the ER staff are willing to do it, until they do it for themselves, it will be a very hard habit to break.
 
That's the gist of several comments from researchers conducting the positive studies I've come across, (going back to the early 2000s).

It's the 'Ol Adage; "Why do we do it that way? Because we've always done it that way."

Its more than likely the ambulance chasing Lawyers, waiting at the wings, that cause the hesitation for change.

Example; the ventilating Nurse in Mellick's video. She was extremely hesitant and resistant to continue to Bag during the HOD Shock Sequence, (i.e. You react like you train)

It wouldn't take but a slightly thicker/insulated PPE Glove to protect you from the slight voltage that is leaking from the AED. What you'll have to make sure of is that your hands are dry and free from Sweat/Bodily Fluids etc. Worst case scenario you'll feel a slight tingling.

The only safety caveat/restriction I see is for CPR Rescuers with a Cardiac History/Pacemaker or other Comorbidity that puts them at a possible risk for their Pump to go "Burp ."

I'm willing to try it, (if someone could hook up an Oscilloscope to me).

The slight leakage from the AED cannot be nearly as bad as "Riding the Lightning"......lol After that, everything seems low voltage..
 
A county I used to work in started doing this years ago. They started doing it after I left. I have not attempted this, but honestly, shockable rhythms are pretty infrequent for me. I've seen them only a handful of times in like the past decade.
 
Or, just shock while the Lucas provides compressions.
 
before we got Lucas ive done it. Now its kinda irrelevant for us.
 
I have been doing Compressions at least 3 times while a patient has been shocked, no issues, as long as you are wearing gloves (and regular ones) there is no problems. Kind of a surprise, and usually a few unkind words from me to the person who pushed the button but it works ok.
 
I've done it for years without any adverse events. Honestly the provider getting shocked just doesn't happen, that's not how electricity works.

I've never felt a tingle from it, the most difficult part about it is the muscle contraction from 360J if you happen to also be starting a line intra arrest
 
Work with a cardiologist that literally lays across the patient's body on the table to stabilize him to avoid dislodging lines.
 
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