The European resuscitation council recommends AL (anterior-lateral) pad positioning while the American Heart Association recommends AL or AP (anterior-posterior) pad placement for defibrillation.
This was a prospective cohort study over a 4 year period in a single EMS jurisdiction. Adult patients with a medical cardiac arrest with an initial rhythm of VT/VF were included. The primary outcome was ROSC at any period of time.
Patients with AP pad placement (compared to AL) had a higher adjusted odds ratio of ROSC at any time (1.34), but not statistically different odds of pulse in the ED, survival to hospital admission or discharge, or functional status at hospital discharge.
The AP pad placement group also required less shocks on average and had earlier and initial sustained rates of ROSC. Further research is needed with respect to initial pad placement in the cardiac arrest population.
References
Lupton JR, Newgard CD, Dennis D, Nuttall J, Sahni R, Jui J, Neth MR, Daya MR. Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Sep 3;7(9):e2431673. doi: 10.1001/jamanetworkopen.2024.31673. Erratum in: JAMA Netw Open. 2024 Nov 4;7(11):e2448135. doi: 10.1001/jamanetworkopen.2024.48135. PMID: 39250154; PMCID: PMC11385052.
