title: Barriers in the implementation of the Resuscitation Guidelines: European survey of defibrillation techniques.
abstract: BACKGROUND
  The European Resuscitation Council (ERC) Guidelines recommend providing chest compressions during defibrillator charging and using adhesive pads for defibrillation to increase the effectiveness of resuscitation. However, the most common defibrillation technique in each European country is unknown, as are the potential barriers in implementation of the guidelines. The aim of this study was to assess the techniques of defibrillation procedures performed by professional European healthcare providers and to estimate how frequently adhesive pads are used.
  
  
  METHODS
  We sent an online questionnaire to the ERC National Representatives that contained 12 questions regarding the techniques of defibrillation and monitoring heart rhythm during cardiac arrest. We also evaluated the frequency and indications of manual paddles use.
  
  
  RESULTS
  We collected questionnaires from 27 out of 33 invited ERC member countries. The response rate was 82%. Seventeen (17/27; 63%) declared the use of adhesive pads. The leading cause for not using adhesive pads was economic reason (9/17; 53%). Some respondents declared resistance to using adhesive pads by healthcare providers or tradition connected with manual paddles use. We found three leading techniques of defibrillation with manual paddles: Charging paddles keeping them on the defibrillator during chest compressions being delivered (9/21; 43%), Charging paddles keeping them on the patient chest during chest compressions being delivered (6/21; 29 %), Charging paddles on the patient chest without chest compressions (5/21; 24%). Respondents from 11 countries declared the use of gel or electrode pastes during defibrillation with manual paddles.
  
  
  CONCLUSIONS
  This study collected preliminary data showing how defibrillation is performed in Europe. It revealed the recommeded techniques underuse and identyfied barriers in the Resuscitation Guidelines implementation. The survey should be open to a wider group of respondents. in each country in future.
  
  
  CONCLUSIONS
  There are limitations and barriers in the implementation of the defibrillation technique guidelines. There are still countries where the use of adhesive pads is low due to economic and traditional reasons. There is a need for further efforts focused on guidelines implementation.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Jagiellonian University Medical College, Kopernika 17, 31-501, Krakow, Poland. p.krawczyk@uj.edu.pl.
authors.forename: Paweł
authors.initials: P
authors.lastname: Krawczyk
authors.affiliation: Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Lazarza 16, 31-530, Krakow, Poland.
authors.forename: Andrzej A
authors.initials: AA
authors.lastname: Kononowicz
authors.affiliation: Department of Anaesthesiology and Intensive Care, Jagiellonian University Medical College, Kopernika 17, 31-501, Krakow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Andres
mesh_terms: D004554:Electric Countershock / Q000379:methods* / Q000592:standards*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005060:Europe; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D012151:Resuscitation / Q000592:standards*
keywords: Adhesive pads; Advanced life support; Cardiopulmonary resuscitation; Coupling medium; Defibrillation; Manual paddles; Monitoring; Technique