• All relevant infection control methods to be utilised.
• If patient is found to be non-responsive and pulseless commence CPR as per Cardiac Arrest guidelines immediately.
• Ensure correct placement of the defibrillation pads for adults^[1] and paediatrics/infants^[2], but DO NOT interrupt CPR to do so.

1. Adult Pad Placement

2. Paediatric Pad Placement

Manual Mode

• Select the appropriate pads for the patient.
• Apply the pads to patient’s bare, dry chest as shown on the packaging.
• Select the desired energy setting.
• Charging:
  • Announce "Charging to [X] joules, continue compressions".
  • Charge the defibrillator and continue compressions.
  • At this time warn, and ensure others are CLEAR.
  • Once charged, an audible alarm will sound.
• Operator and Compressor must communicate clearly and unambiguously.
• Using a tactile hand tap, announce "STOP Compressions". Compressor must stop and hover.
• Shocking:
  • Both Operator and Compressor should assess rhythm; "Confirm shockable / non-shockable".
  • If shockable, deliver shock.
  • If non-shockable, disarm the device.
• Using a tactile hand tap, announce "Resume Compressions".
• Continue CPR as necessary & assess rhythm every 2 minutes.
  

NB: Tactile hand taps are an important and necessary safety feature to minimise risk of accidental shock to rescuers and is a MANDATORY component of IMPACT CPR.

Corpuls

Automatic Mode (Zoll / FR3 / FRx)

• To initiate Automatic mode:
  • If using Corpuls, select AED mode.
  • If using the Zoll, select "Defib" mode on the dial, and then press "Anaylse".
  • If using the FR3 AED, simply open the case and it will automatically turn the unit on. If it does not turn on immediately, press the green power button on the unit.
  • If using the FRx AED, open the case and turn on the unit by pressing the green power button.
• If using the FRx/FR3 AED on an infant/child under weight of 25kg or < 8 years insert the infant/child key immediately.
• When using in Automated External Defibrillator (AED) mode ensure the audio and visual instructions are followed. Devices will analyse rhythms automatically.
• When the device prompts so, warn and ensure others are CLEAR.
• One officer may support this by using a tactile hand tap, announcing "STOP Compressions". Compressor must stop and hover.
• If shockable, the unit will emit a beep when fully charged. If shockable, the device will prompt a shock to be delivered.
• After the shock is delivered, using a tactile hand tap, announce "Resume Compressions"; the compressor must resume.
• Continue to follow the prompts, and CPR, as appropriate.

Zoll M

 

Philips Laerdal FR3

Philips Laerdal FRx

• Patients in shock-refractory VF/VT (>3 shocks) can benefit from a change in electrical vector to assist in terminating the rhythm
• To be considered shock-refractory there must be no termination of the shockable rhythm between shocks

Defibrillation pad placement – Vector Change

• Keeping the original pads in situ, place a second set of defibrillation pads in anterior/posterior (AP) position - as shown with pads 2A and 2B on the diagram.
• Label both sets of leads - A/L for the standard (Antero-Lateral) placement, and A/P for the new (Anterior/Posterior) placement.
• Change to the AP pad cord on the monitor
• Continue as normal with IMPACT resuscitation, using the AP pad placement for further defibrillation attempts

Double Sequential Defibrillation

Double sequential defibrillation (DSED) is the instance of two sequential (<1 second apart) shocks using two sets of pads and two monitors with the pads in the anterior/lateral and anterior/posterior placement. One person who is trained and authorised must discharge both defibrillators sequentially.

• Connect one Corpuls3 monitor to each set of pads (AL and AP placement), ensuring it is known which monitor is connected to which pads.
• Charge both monitors as normal for a status check.
• Defibrillator operator to perform tactile hand tap and announce"stop compressions" as above prior to rhythm check
• If non-shockable, disarm charge on both monitors
• If shockable, deliver shock from both monitors, first using AL pads followed by AP.
• Announce "continue compressions" with tactile hand tap.

Safety considerations:

• Simultaneous defibrillation from both monitors may cause damage to the monitors and has unknown patient effect.
• Unfamiliarity with using two monitors may lead to accidental shocks if another clinician resumes compressions too early.
• Tactile hand-taps are mandatory.
• One clinician should perform hand-tap to stop compressions, defibrillate with both monitors, and perform second hand-tap to resume compressions using the same hand to ensure the correct sequence is followed.

Defibrilator pad placement:
1A/1B: Antero-lateral (standard) placement
2A/2B: Antero-posterior placement