Is external defibrillation an electric threat for bystanders?
BACKGROUND
Safety precautions during defibrillation and cardioversion are generally taken very seriously. The actual hazard for bystanders and rescuers, however, has rarely been investigated. Recently, continuing chest compressions during defibrillation has been suggested to improve outcome from cardiac arrest. This article is to review reports on electric shocks to persons other than patients and to discuss the pertinent biomedical principles.


METHODS
Systematic search in medical literature databases and consecutive hand-search of reference lists.


RESULTS
A total of 29 adverse events are reported in the medical literature; seven due to accidental or intentional defibrillator misuse, three due to device malfunction, four during training/maintenance procedures, and 15 during regular resuscitation efforts. Tingling sensations and minor burns are frequently reported consequences of inadvertent shocks. There are no accounts on immediate life-threatening conditions or long-term disability in rescuers/bystanders inflicted by defibrillation/cardioversion of a patient. Discharging a defibrillator directly to a healthy person's chest can be lethal.


CONCLUSIONS
External electric therapy is likely to be safer than traditionally assumed, especially with self-adhesive thoracic electrodes. Sound clinical experiments are urgently needed before safety measures are revised.
Hoke
Robert Sebastian
RS
Department of Medicine III, Halle University Hospital, Ernst-Grube-Str. 40, 06097 Halle (Saale), Germany. robert.hoke@yahoo.de
Heinroth
Konstantin
K
Trappe
Hans-Joachim
HJ
Werdan
Karl
K
D016887:Cardiopulmonary Resuscitation; D047548:Defibrillators / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects*; D004556:Electric Injuries / Q000209:etiology*; D004868:Equipment Failure; D006801:Humans; D018570:Risk Assessment