TY - JOUR
T1 - Pad size, orientation, and placement for defibrillation during basic life support
T2 - A systematic review
AU - Ristagno, Giuseppe
AU - Semeraro, Federico
AU - Raffay, Violetta
AU - Stirparo, Giuseppe
AU - Lulic, Ileana
AU - Deakin, Charles D.
AU - Drennan, Ian R.
AU - Del Castillo, Jimena
AU - Acworth, Jason
AU - Morley, Peter T.
AU - Perkins, Gavin D.
AU - Smith, Micheal
AU - Olasveengen, Theresa M.
AU - Bray, Janet E.
AU - Skrifvars, Markus
AU - Berg, Katherine M.
AU - Moskowitz, Ari
AU - Granfeldt, Asger
AU - Grunau, Brian
AU - Zelop, Carolyn
AU - Pocock, Helen
AU - Hirsch, Karen G.
AU - Couper, Keith
AU - Holmberg, Mathias J.
AU - Nikolaou, Nikolaos
AU - Fernando, Shannon M.
AU - Ohshimo, Shinichiro
AU - D'Arrigo, Sonia
AU - Scquizzato, Tommaso
AU - Chia, Yew Woon
AU - Leong, Carrie
AU - Crow, Conor
AU - Lok, Neville
AU - Bottiger, Bernd
AU - O'Neil, Brian
AU - Soar, Jasmeet
AU - Parr, Michael
AU - Welsford, Michelle
AU - Kudenchuk, Peter
AU - Neumar, Robert W.
AU - Nicholson, Tonia
AU - Nolan, Jerry P.
AU - Lavonas, Eric J.
AU - Sandroni, Claudio
AU - Ng, Kee Chong
AU - Scholefield, Barnaby R.
AU - Topjian, Alexis
AU - Lopez-Herce, Jesus
AU - Christoff, Andrea
AU - Morgan, Ryan W.
AU - International Liaison Committee on Resuscitation Basic Life Support Task Force Members
AU - Advanced Life Support Task Force Members
AU - Pedriatic Life Support Task Force Members
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/9
Y1 - 2025/9
N2 - Aim: To evaluate the impact of defibrillation pad size, orientation, and position on clinical outcomes in adult and paediatric cardiac arrest with a shockable rhythm through a systematic review of available evidence. Methods: A systematic review was registered with PROSPERO (CRD42024512443). Searches were performed across PubMed, EMBASE, and the Cochrane Library up to March 31st, 2025. Studies involving adults or children with cardiac arrest and comparing pad sizes or positions were included. Risk of bias was assessed using the RoB 2.0 and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE methodology. Results: Of 7855 screened studies, four met inclusion criteria, e.g. 1 randomized clinical trial (RCT) and 3 observational studies in adults, covering 1334 adult cardiac arrest patients. Evidence on pad size, deriving from an observational study enrolling 314 patients, was sparse and inconclusive, with no significant differences in defibrillation success between large and small pads (OR 0.82[0.42–1.60]). For pad orientation, no evidence was found. For pad placement, one RCT including 280 patients suggested a potential survival benefit from vector-change defibrillation using anterior-posterior (AP) pad placement in refractory ventricular fibrillation (VF), compared to the standard anterior-lateral (AL) placement (adj. RR 1.71[1.01–2.88]). Data from two observational studies including 739 patients were conflicting and limited by high risk of bias. Conclusion: Evidence remains inconclusive to support the superiority of any specific pad size, orientation or position for improving survival or neurological outcomes in cardiac arrest. However, vector-change to the AP position may offer benefit in cases of refractory VF. High-quality RCTs are needed to further inform clinical practice.
AB - Aim: To evaluate the impact of defibrillation pad size, orientation, and position on clinical outcomes in adult and paediatric cardiac arrest with a shockable rhythm through a systematic review of available evidence. Methods: A systematic review was registered with PROSPERO (CRD42024512443). Searches were performed across PubMed, EMBASE, and the Cochrane Library up to March 31st, 2025. Studies involving adults or children with cardiac arrest and comparing pad sizes or positions were included. Risk of bias was assessed using the RoB 2.0 and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE methodology. Results: Of 7855 screened studies, four met inclusion criteria, e.g. 1 randomized clinical trial (RCT) and 3 observational studies in adults, covering 1334 adult cardiac arrest patients. Evidence on pad size, deriving from an observational study enrolling 314 patients, was sparse and inconclusive, with no significant differences in defibrillation success between large and small pads (OR 0.82[0.42–1.60]). For pad orientation, no evidence was found. For pad placement, one RCT including 280 patients suggested a potential survival benefit from vector-change defibrillation using anterior-posterior (AP) pad placement in refractory ventricular fibrillation (VF), compared to the standard anterior-lateral (AL) placement (adj. RR 1.71[1.01–2.88]). Data from two observational studies including 739 patients were conflicting and limited by high risk of bias. Conclusion: Evidence remains inconclusive to support the superiority of any specific pad size, orientation or position for improving survival or neurological outcomes in cardiac arrest. However, vector-change to the AP position may offer benefit in cases of refractory VF. High-quality RCTs are needed to further inform clinical practice.
KW - Anterior-lateral
KW - Anterior-posterior
KW - Defibrillation
KW - Outcome
KW - Pads position
KW - Vector
UR - https://www.scopus.com/pages/publications/105011143849
U2 - 10.1016/j.resplu.2025.101030
DO - 10.1016/j.resplu.2025.101030
M3 - Review
C2 - 40741375
AN - SCOPUS:105011143849
SN - 2666-5204
VL - 25
JO - Resuscitation Plus
JF - Resuscitation Plus
M1 - 101030
ER -