Impact of secondary anterior-posterior defibrillator pad placement on chest compression interruptions: a three-arm randomised manikin-based simulation study among Dutch ambulance teams

Background

Out-of-hospital cardiac arrest management prioritises effective treatment, with high-quality chest compressions and timely defibrillation being essential. While current European Resuscitation Council guidelines recommend sternal-apical defibrillator pad placement, alternative positions such as anterior-posterior (AP) are gaining interest. The integration of secondary AP pad placement with mechanical cardiopulmonary resuscitation devices (mCPR) remains underexplored.

Methods

This randomised, simulation-based study, assessed the impact of AP pad placement on chest compression interruptions, comparing manual versus mCPR strategies among 45 ambulance teams in the Netherlands. Teams were randomised into three groups: manual chest compressions with AP pad application, sequential mCPR and AP pad application, or simultaneous mCPR and AP pad application. The primary outcome was the duration of chest compression interruptions; secondary outcomes included user-feasibility and pad placement accuracy.

Results

Applying AP pads during manual compressions required 38.3 ± 13.3 s, resulting in 12.1 ± 6.0 s of interruptions. Sequential mCPR and AP pad application took 97.7 ± 23.7 s, with 51.7 ± 14.0 s of interruptions. Simultaneous application required 70.5 ± 16.1 s and 31.8 ± 12.3 s of interruptions. Pad placement accuracy was low: 0 % for sternal, 11 % for apical, 13 % for anterior and 2 % for posterior pads. Participants’ confidence in pad placement did not correlate with accuracy.

Conclusion

AP defibrillator pad placement during active mCPR presents significant challenges. Ambulance crews should assess the need for AP pads before initiating mCPR to minimise delays. The findings highlight substantial variability in pad placement, underscoring the need for standardised instructional guidelines and targeted training.