New research suggests that most physicians in the UK, irrespective of grade or speciality, do not know where to place defibrillator paddles when performing cardiac resuscitation.
Researchers from Southampton General Hospital asked 101 physicians from all grades of acute specialities to place defibrillator paddles on an anatomically correct resuscitation mannequin. Included among these physicians were 20 consultants, 38 registrars, 31 senior house officers, 10 preregistration house officers and two staff grades.
Sixty five per cent of the sternal paddles (which guidelines say should be placed “below the right clavicle [collar bone] in the mid clavicular line”) were placed more or less correctly (within 5 cm of the recommended position).
But only 22 per cent of the apical paddles were placed within 5 cm of the correct position, with most being placed either too high or too far over towards the center of the chest.
An incorrect positioning results in a greater percentage of current not passing through heart tissue, and so reduces the chances of successful defibrillation.
The guidelines used in this observational study were those laid down by the European Resuscitation Council. Since the study was conducted, however, new guidelines from the International Liaison Committee on Resuscitation (ILCOR) have been implemented, specifying that the apical paddle should be placed even further towards the side “to the left of the nipple with the centre of the electrode in the midaxillary [armpit] line”.
The most likely explanation for these physicians’ lack of skill is that either they were never taught correct paddle placement in the first place, and bad habits have simply been passed down from one physician to another (BMJ, 2001; 322: 1393-4).