Defibrillation: prevention, safety and literacy are key

To the Editor,

Recently, an incident occurred during a cardiopulmonary resuscitation (CPR) simulation training session that shook the French academic world.¹ The session followed the standard procedure: it took place in a simulation center with a high-fidelity mannequin and a manual defibrillator, and included a briefing, the simulation itself, and a debriefing. These sessions aim to resemble real-life situations. At the end of the session, a medical student mistakenly believed that the defibrillator was a dummy and applied its paddles to his own cheeks before delivering a 200-joules shock. The student lost consciousness immediately and was treated by a teacher who is an intensive care physician. The student recovered quickly and, after 24 h of observation in the intensive care unit, was able to return home unharmed. Following this incident, a reminder was sent to teachers nationwide. It is imperative to strictly separate clinical and simulation equipment and implement safety procedures for defibrillators.

Beyond this potentially tragic event, we believe that, in the year of the publication of the guidelines, it is essential to highlight that, while rapid defibrillation remains the standard treatment for patients with ventricular fibrillation or pulseless ventricular tachycardia, it can be harmful in the event of intentional or unintentional misuse or device malfunction. Many studies aimed at improving the effectiveness of defibrillation, if applied without caution, could pose a low but existing risk to first responders and lay rescuers.

Indeed, manually increasing pressure on the electrodes during defibrillation can reduce impedance and improve defibrillation success.² However, caregivers are then at risk of electrocution. To limit these risks to the rescue team while maintaining chest compressions during shock administration, the use of polyethylene gloves has been proposed to prevent brief interruptions associated with defibrillation.³

Using two defibrillators for dual defibrillation shows promising results in cases of refractory cardiac arrest.⁴ Equipping volunteer citizens with defibrillators, as has been done in the Angers region of France, makes these devices accessible to less-trained individuals who are more vulnerable to these risks.⁵ Therefore, it is important to inform these citizen rescuers to prevent these exceptional events. We strongly believe that having complete information will not negatively affect resuscitation and will efficiently prevent electrocutions, in accordance with the principle of health literacy.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.