Faculty of Healthcare Sciences, University of Southampton, Southampton, UK.
Medical School, University of Southampton, Southampton, UK.
Resuscitation. 2019 Apr;137:148-153. doi: 10.1016/j.resuscitation.2019.02.011. Epub 2019 Feb 19.
Implantable cardioverter-defibrillators (ICDs) are a well-established therapy for patients at risk of life-threatening ventricular arrhythmias. With rising implant rates, the risk of a rescuer performing chest compressions during discharge is increasing, leading to concerns over rescuer safety from the resultant leakage current. More recently, subcutaneous ICDs (S-ICD) have been developed, which utilise a higher energy and more superficial electrodes compared with transvenous ICDs (T-ICD), raising safety concerns further.
We measured the current a rescuer would potentially receive from T-ICDs and S-ICDs if they were in contact with the patient at the time of ICD discharge to assess its magnitude in relation to international safety standards.
Surface voltages adjacent to ICD electrodes were measured on patients undergoing defibrillation threshold checks. Rescuer current was then calculated assuming a total rescuer circuit impedance of 1696 Ω.
Twenty-five patients were recruited. Rescuer current from S-ICDs was significantly higher than those from T-ICDs (S-ICD: Median RMS 135 mA range 91 mA-164 mA, T-ICD: Median RMS 31 mA, range 9 mA-75 mA, P < 0.0001). Surface voltages (median RMS) to which the rescuer is likely to be exposed are higher when performing chest compressions from the patient's left side compared with the right (127 V vs 67 V respectively, 95% CI of difference -34 V to -67 V, P < 0.0001).
Rescuers performing chest compressions on ICD patients are at risk from leakage current, particularly from S-ICDs. Chest compressions should be performed from the opposite side to the ICD to reduce rescuer risk.
植入式心脏复律除颤器（ICD）是一种治疗有生命威胁性室性心律失常风险的患者的成熟疗法。随着植入率的上升，在患者出院期间进行心肺复苏的急救者发生接触的风险也在增加，由此导致对急救者因漏电流而产生的安全性产生担忧。最近，已经开发出皮下 ICD（S-ICD），与经静脉 ICD（T-ICD）相比，它使用更高的能量和更浅表的电极，这进一步增加了安全性方面的担忧。
我们测量了如果在 ICD 放电时急救者与患者接触，T-ICD 和 S-ICD 可能会使急救者接收到的电流，以评估其与国际安全标准的关系。
对接受除颤阈值检查的患者进行 ICD 电极附近的表面电压测量。然后，假设总急救者电路阻抗为 1696 Ω，计算急救者电流。
共招募了 25 名患者。S-ICD 的急救者电流明显高于 T-ICD（S-ICD：中位数 RMS 135 mA，范围 91 mA-164 mA；T-ICD：中位数 RMS 31 mA，范围 9 mA-75 mA，P<0.0001）。当从患者的左侧进行胸部按压时，急救者可能暴露的表面电压（中位数 RMS）高于右侧（分别为 127 V 和 67 V，差异的 95%置信区间为-34 V 至-67 V，P<0.0001）。
对 ICD 患者进行胸部按压的急救者有漏电流的风险，特别是来自 S-ICD。应从 ICD 的相反侧进行胸部按压以降低急救者的风险。
