Abstract 116: Evaluating the Safety of Hands-on Defibrillation: Electrical Breakdown Voltages of Medical Examination Gloves
Background: Hands-on defibrillation has been proposed as a strategy to reduce pauses in chest compressions during CPR. Common biphasic defibrillators utilize voltages of about 1400–1800V for first shock doses and up to 2800V at maximum settings; monophasic defibrillators go much higher, up to 5000V. The safety for the rescuer of contacting the patient's chest during these shocks is a function of two variables - the fraction of the shock voltage presented to the rescuer, and the breakdown voltage of the gloves worn by the rescuer. Neither variable has been adequately investigated. We determined the electrical breakdown voltage for a variety of medical examination gloves.
Methods: We used a dielectric analyzer to apply an increasing voltage ramp to each glove until a failure was detected or 5000V was reached. A failure was defined as an electrical arc or a current flow in excess of 100 micro-amps. This current limit was set based on existing safety standards. Single-layer measurements were made on 40 latex, 40 nitrile, 40 vinyl, and 40 chloroprene gloves. In addition, double-glove measurements were made on pairs of 40 nitrile and 40 vinyl gloves.
Results: A majority (30/40) of latex glove measurements exceeded 5000V without failure. Of the latex glove failures, the mean (range) voltage was 4377V (3000–5000V). All of the other single-layer gloves failed with these voltages: vinyl: 1029V (604–2521V), nitrile: 1544V (811–2697V), chloroprene: 3037V (2250–3968V). Double-gloves failed at: vinyl: 1072V (789 – 1581V), nitrile: 2479V (2092–3591V). Double-gloving increased the breakdown voltage of nitrile (p<.001) but not vinyl (p=0.60) gloves.
Conclusions: The electrical breakdown voltage of medical examination gloves varied considerably between glove types, and some failed below common first-shock voltages even when worn in two layers. The other variable related to safety of hands-on defibrillation, the fraction of the shock voltage presented to the rescuer, may be difficult to assess because of the non-linear nature of skin impedance. Until this fraction is firmly established it may be prudent to use gloves with a breakdown voltage exceeding the maximum defibrillator output. Additional research is thus needed to establish safe methods of hands-on defibrillation.
- © 2010 by American Heart Association, Inc.