title: Adherence to guidelines when positioning the defibrillation electrodes.
abstract: BACKGROUND
  Placement of the defibrillation electrodes affects the transmyocardial current and thus the success of a defibrillation attempt. In the international guidelines 2000, the placement of the apical electrode was changed more laterally to the mid-axillary line. Finnish national guidelines, based on the international guidelines, were published in 2002.
  
  
  OBJECTIVE
  The purpose of this study was to determine to what extent health care professionals adhere to the new guidelines when positioning the electrodes.
  
  
  METHODS
  Professionals were recruited from emergency medical services, university hospitals and primary care. Not revealing the purpose of the test, participants were asked to place self-adhesive electrodes on a manikin as they would do in the resuscitation situation and to answer a questionnaire about resuscitation training and familiarity with the guidelines. The distance of electrodes from the recommended position was measured in horizontal and vertical planes.
  
  
  RESULTS
  One-hundred and thirty six professionals participated in the study, and only 25.4% (95% CI 18.5-32.9) of them placed both electrodes within 5 cm from the recommended position. The majority of the participants placed the apical electrode too anteriorly. Of the participants, 36.0% were not aware of the new guidelines. Awareness of the guidelines did not increase the accuracy in electrode placement.
  
  
  CONCLUSIONS
  The publication of the national evidence based resuscitation guidelines did not seem to have influenced the practice of placement of the defibrillation electrodes to any major extent. The correct placement of the electrodes needs be emphasized more in the resuscitation training.
authors.affiliation: Uusimaa EMS, Helsinki University Hospital, Eteläinen Hesperiankatu, 22A 26, Helsinki 00100, Finland. jouni.nurmi@helsinki.fi
authors.forename: Jouni
authors.initials: J
authors.lastname: Nurmi
authors.forename: Per
authors.initials: P
authors.lastname: Rosenberg
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
mesh_terms: D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000592:standards*; D002983:Clinical Competence; D016001:Confidence Intervals; D004554:Electric Countershock / Q000295:instrumentation* / Q000592:standards*; D004566:Electrodes; D004632:Emergency Medical Services; D005260:Female; D005387:Finland; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011336:Probability; D017749:Total Quality Management