Cattermole G, McKay N
Emergency Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK.
Emerg Med J. 2006 Feb;23(2):147-8. doi: 10.1136/emj.2005.028340.
Successful defibrillation of a patient with dextrocardia using conventional anterolateral paddle positions raises doubts about the necessity to place paddles in the exact recommended positions. Evidence found relates either to volunteers in a laboratory setting or to defibrillation of atrial arrhythmias. The conclusion is that there is no published difference either in transthoracic impedance or in success of defibrillation between anteroposterior and anterolateral paddle positions. In the absence of any evidence for an ideal apical paddle position in the standard anterolateral defibrillation of ventricular arrhythmias, the emphasis in ALS and resuscitation guidelines on "correct" positioning seems misplaced, and, by adding unnecessary information, may hinder learning the skill of defibrillation. Early defibrillation is crucial to successful recovery from cardiac arrest and anything that delays cardioversion should be avoided. The limited evidence suggests that the exact position of the paddles does not matter. The time taken to find the "correct" position is time wasted and it may instead be preferable to teach people merely to place the apical paddle to the left of the nipple in the midaxillary line.
使用传统的前外侧电极板位置对右位心患者成功除颤，引发了对于是否有必要将电极板置于确切推荐位置的质疑。所发现的证据要么与实验室环境中的志愿者有关，要么与房性心律失常的除颤有关。结论是，在前后位和前外侧电极板位置之间，经胸阻抗或除颤成功率均无已发表的差异。在室性心律失常的标准前外侧除颤中，缺乏关于理想的心尖部电极板位置的任何证据，因此，高级生命支持（ALS）和复苏指南中对“正确”定位的强调似乎失当，而且，通过添加不必要的信息，可能会妨碍除颤技能的学习。早期除颤对于心脏骤停的成功复苏至关重要，应避免任何延迟心脏复律的情况。有限的证据表明，电极板的确切位置并不重要。寻找“正确”位置所花费的时间是浪费的，相反，或许最好是教导人们仅将心尖部电极板置于腋中线乳头左侧。
