R E SUS CI TATION
energy settings of the defibrillator for an adult, use the highest energy setting for all shocks (expert opinion).”11
The debate over high vs low level shocks continues, but findings such as these should be considered when making equipment decisions.
When choosing higher energy levels for patients, safety is a key consideration, with successful defibrillation causing as little myocardial damage as possible during the resuscitation attempt. Studies in the ERC guidelines show that biphasic waveforms up to 360 J have not been found to cause harm to humans (including raised biomarkers, ECG changes, ejection fraction).11
So, while
the ERC recognises there are studies in animals that suggest a potential for harm with higher shocks, it appears the danger to humans from high energy shocks remains low.11
Standardisation
Another area of the RCUK guidelines aiming to improve patient safety is the standardisation of resuscitation equipment. Standardising resuscitation equipment helps improve training and reduce the variability of care, lowering the risk of errors or delays in high-pressure situations. Embarking on a standardisation project can help hospitals acquire devices that meet changing criteria and secure compliance with future healthcare directives. The Betsi Cadwaladr University Health Board in North Wales used its own standardisation project to find devices that could satisfy their usability requirements and end a long search for the right devices.
Sarah Bellis, resuscitation services manager at Betsi Cadwaladr University Health Board, said: “It has been a long search for the right product but, with Mindray’s defibrillators, we have found devices that are extremely user-friendly and consider the human factors at work in a resuscitation attempt. We particularly like the clear mode-selection dial on the manual device, helping users easily navigate the device in high-pressure situations.” Mindray recently provided over 450 defibrillators for the Board, supplying a mix of automated external defibrillators (AED) and manual devices for the entire North Wales region. The manual devices are all connectivity-ready and will be able to assist the Board in meeting future digital healthcare directives, as well as meeting current RCUK guidelines.
The RCUK recommends that clinicians must review cardiac arrest data to help improve training and response times, which can be easily achieved with the D3 and D6 but can be supported by future connectivity. The devices’ extensive storage capabilities allow for the capture of trending of up to
SEPTEMBER 2021
24 hours ECG, 1000 events, 72 hours of measured parameters and 60 minutes voice recording. With Wi-Fi modules this vital data can be sent to electronic patient records in advance, supporting efficient decision making and safer patient care.
The updated guidelines offer healthcare organisations across the UK an opportunity to re-evaluate their resuscitation equipment and processes. There is now more freedom than ever for resuscitation officers to act on their own experiences, but devices must be able to support their decisions with rapid high-energy shocks, reliable usability, and intelligent monitoring. Satisfying these criteria alongside UK guidelines will help organisations to provide the highest levels of patient safety during resuscitation attempts.
References 1 Soar J, Deakin C, Nolan J, et al. The Resuscitation Council (UK): Adult advanced life support guidelines. 2021.
https://www.resus.org.uk/ library/2021-resuscitation-guidelines/adult- advanced-life-support-guidelines (cited June 2021)
2 The Resuscitation Council (UK). The ABCDE Approach.
https://www.resus.org.uk/library/abcde- approach (cited June 2021)
3 The Resuscitation Council (UK): Adult advanced life support guidelines. 2021.
4 Priori SG, Blomstrom-Lundqvist C. European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death summarized by co-chairs. Eur Heart J 2015; 36: 2757-9.
5 Edelson DP, Abella BS, Kramer-Johansen J, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006; 71(2): 137-45.
6 Soar J, et al., European Resuscitation Council Guidelines 2021: Adult advanced life support, Resuscitation 2021; 161:115-151.
About the author
James Swarbrick is the regional account manager for Mindray UK covering defibrillation, patient monitoring, anaesthesia and ventilation solutions. With over 20 years’ experience in medical devices spanning the NHS and commercial sector, he is passionate about improving patient care through advancements in medical technology. Originally a biomedical scientist in the NHS, he has an MSc in Clinical Chemistry.
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7 The Resuscitation Council (UK): Adult advanced life support guidelines. 2021.
8 European Resuscitation Council Guidelines 2021: Adult advanced life support.5
9 Koster RW, Walker RG, Chapman FW. Recurrent ventricular fibrillation during advanced life support care of patients with prehospital cardiac arrest. Resuscitation 2008;78: 252-7.
10 Morrison LJ, Henry RM, Ku V, et al. Single-shock defibrillation success in adult cardiac arrest: a systematic review. Resuscitation 2013; 84:1480-6.
11 European Resuscitation Council Guidelines 2021: Adult advanced life support.14
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