Ristagno Giuseppe, Semeraro Federico, Raffay Violetta, Stirparo Giuseppe, Lulic Ileana, Deakin Charles D, Drennan Ian R, Del Castillo Jimena, Acworth Jason, Morley Peter T, Perkins Gavin D, Smith Micheal, Olasveengen Theresa M, Bray Janet E
Department of Pathophysiology and Transplantation, University of Milan, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Resusc Plus. 2025 Jul 14;25:101030. doi: 10.1016/j.resplu.2025.101030. eCollection 2025 Sep.
To evaluate the impact of defibrillation pad size, orientation, and position on clinical outcomes in adult and paediatric cardiac arrest with a shockable rhythm through a systematic review of available evidence.
A systematic review was registered with PROSPERO (CRD42024512443). Searches were performed across PubMed, EMBASE, and the Cochrane Library up to March 31st, 2025. Studies involving adults or children with cardiac arrest and comparing pad sizes or positions were included. Risk of bias was assessed using the RoB 2.0 and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE methodology.
Of 7855 screened studies, four met inclusion criteria, e.g. 1 randomized clinical trial (RCT) and 3 observational studies in adults, covering 1334 adult cardiac arrest patients. Evidence on pad size, deriving from an observational study enrolling 314 patients, was sparse and inconclusive, with no significant differences in defibrillation success between large and small pads (OR 0.82[0.42-1.60]). For pad orientation, no evidence was found. For pad placement, one RCT including 280 patients suggested a potential survival benefit from vector-change defibrillation using anterior-posterior (AP) pad placement in refractory ventricular fibrillation (VF), compared to the standard anterior-lateral (AL) placement (adj. RR 1.71[1.01-2.88]). Data from two observational studies including 739 patients were conflicting and limited by high risk of bias.
Evidence remains inconclusive to support the superiority of any specific pad size, orientation or position for improving survival or neurological outcomes in cardiac arrest. However, vector-change to the AP position may offer benefit in cases of refractory VF. High-quality RCTs are needed to further inform clinical practice.
通过对现有证据进行系统评价，评估除颤垫尺寸、方向和位置对可电击心律的成人及儿童心脏骤停临床结局的影响。
一项系统评价已在PROSPERO（CRD42024512443）注册。截至2025年3月31日，在PubMed、EMBASE和Cochrane图书馆进行了检索。纳入涉及心脏骤停的成人或儿童且比较除颤垫尺寸或位置的研究。使用RoB 2.0和ROBINS-I工具评估偏倚风险，并使用GRADE方法评估证据的确定性。
在7855项筛选的研究中，4项符合纳入标准，即1项成人随机临床试验（RCT）和3项观察性研究，涵盖1334例成人心脏骤停患者。来自一项纳入314例患者的观察性研究的关于除颤垫尺寸的证据稀少且无定论，大尺寸和小尺寸除颤垫在除颤成功率上无显著差异（比值比0.82[0.42 - 1.60]）。关于除颤垫方向，未找到证据。关于除颤垫放置，一项纳入280例患者的RCT表明，与标准的前侧位（AL）放置相比，在难治性室颤（VF）中使用前后位（AP）除颤垫放置进行矢量改变除颤可能具有生存获益（调整后风险比1.71[1.01 - 2.88]）。两项纳入739例患者的观察性研究的数据相互矛盾且受高偏倚风险限制。
尚无确凿证据支持任何特定的除颤垫尺寸、方向或位置在改善心脏骤停患者生存或神经学结局方面具有优越性。然而，在难治性VF病例中，改为AP位置进行矢量改变可能有益。需要高质量的RCT来进一步指导临床实践。
