title: Layperson positioning of defibrillation electrodes guided by pictorial instructions.
abstract: BACKGROUND
  Correct positioning of defibrillation electrodes is essential to achieve sufficient transmyocardial current to depolarize a critical mass of myocardium, and thus terminate ventricular fibrillation (VF).
  
  
  OBJECTIVE
  To evaluate the pictures on the self-adhesive defibrillation electrodes in guiding laypersons to place the electrodes in the recommended position.
  
  
  METHODS
  Defibrillation electrodes from five manufactures (Access Cardio Systems, Schiller, Medtronic, Cardiac Science and Philips) were included in the study and compared with electrodes with a lateral view picture, designed for the study, showing the placement of the apical electrode. A total of 150 laypersons without any experience or training in use of a defibrillator participated in the study. The participants placed randomly selected electrodes on the chest of a resuscitation manikin without any guidance apart from the pictures on the electrodes. The distances of the electrodes from the recommended positions were measured.
  
  
  RESULTS
  The proportion of participants who placed both electrodes within 5 cm from recommended position varied from 8% to 36% with the different electrodes. Usually, the apical electrode was placed too anteriorly. Electrodes placed with help of the lateral instruction picture, (designed for the study), showing the placement of the apical electrode were placed significantly more often within 5 cm than any of the others (64%, 95% confidence interval 44-80, P < 0.05).
  
  
  CONCLUSIONS
  The current practice in designing pictures on the electrodes does not seem to be optimal in showing the recommended position of the apical electrode as recommended by Guidelines 2000. It is suggested that by showing a lateral view in the instructions, success in placing the apical electrodes correctly can be improved.
authors.affiliation: Uusimaa Emergency Medical Services, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Finland. jouni.nurmi@helsinki.fi
authors.forename: Jouni
authors.initials: J
authors.lastname: Nurmi
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000193:education*; D002983:Clinical Competence; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation* / Q000379:methods*; D004566:Electrodes; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D013663:Teaching / Q000379:methods*