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(Circulation. 2008;117:2435-2436.)
© 2008 American Heart Association, Inc.

Editorial

"I’m Clear, You’re Clear, Everybody’s Clear"

A Tradition No Longer Necessary for Defibrillation?

Richard E. Kerber, MD

From the Cardiology Division, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Correspondence to Richard E. Kerber, Professor of Medicine, Cardiology Division, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242. E-mail richard-kerber@uiowa.edu

Key Words: Editorials • cardiopulmonary resuscitation • cardioversion • defibrillation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In emergency defibrillation of ventricular arrhythmias or elective cardioversion of atrial arrhythmias, a potent electric shock is passed through the torso of the patient to briefly terminate all electrical activity and allow an organized, perfusing rhythm to emerge. The electric shock is administered via electrodes placed on the patient’s chest, usually in anterior-apical or anterior-posterior positions. For many years, hand-held paddle electrodes were pressed by a rescuer against the patient’s chest; more recently, pregelled self-adhesive electrode pads with nonconductive backing have achieved widespread use.

Article p 2510

Possible danger to a rescuer compressing the chest or simply touching a patient who is receiving a defibrillating shock has long been recognized; stray electric current passing through a rescuer could possibly induce a lethal arrhythmia. Such danger would be heightened if the rescuer were simultaneously in contact with highly conductive material (ie, body fluids or leaking or disrupted intravenous fluid cannulas). To avoid this hazard, generations of rescuers, from lay persons to cardiologists, have been instructed to "clear" the patient before shock delivery.^1,2 Physical separation of the rescuer from the patient ensures that no electric current will inadvertently enter the rescuer’s body and thereby ensures safety. But in clearing the patient, chest compressions are necessarily interrupted. Such interruptions are undesirable; they degrade the quality of cardiopulmonary resuscitation and are contrary to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which call for minimizing interruptions to chest compression.¹

In this issue of Circulation, Lloyd et al³ report . . . [Full Text of this Article]