Pad size, orientation, and placement for defibrillation during basic life support: A systematic review

作者：Giuseppe Ristagno, Federico Fiorenzo Semeraro, Violetta I. Raffay, Giuseppe Stirparo, Ileana Lulić, Charles D. Deakin, Ian R. Drennan, Jimena Del Castillo, Jason Acworth, Peter Thomas Morley, Gavin D. Perkins, Micheal Smith, Theresa Mariero Olasveengen, Janet E. Bray, Anthony T. Lagina, Baljit Singh, Julie Considine, Sung Phil Chung, Vihara Erangika Gunasekera Dassanayake, Katie N. Dainty, Guillaume P. Debaty, Maya L. Dewan, Bridget L. Dicker, Fredrik Folke, George Lukas, Carolina Malta Hansen, Nicholas James Johnson, Rebecca E. Cash, Takanari Ikeyama, Siobhán Masterson, Emily Nehme, Tatsuya Norii, Aloka Samantaray, Anastasia Spartinou, Christopher Matthew Smith, Christian Vaillancourt, Markus B. Skrifvars, Katherine Margaret Berg, Ari L. Moskowitz, Asger Granfeldt, Brian E. Grunau, Carolyn M. Zelop, Helen Pocock, Karen G. Hirsch, Keith Couper, Mathias Johan J Holmberg, Nikolaos I Nikolaou, Shannon M. Fernando, Shinichiro Ohshimo, Sonia D’Arrigo, Tommaso Scquizzato, Yew Woon Chia, Carrie Kah‐Lai Leong, Conor Crow, Neville Lok, Bernd Walter Böttiger, Brian J. O’Neil, Jasmeet Soar, Michael J. Parr, Michelle Welsford, Peter J. Kudenchuk, Robert W. Neumar, Tonia Nicholson, Jerry P. Nolan, Eric J. Lavonas, Claudio Sandroni, Kee-Chong Ng, Barnaby R. Scholefield, Alexis Topjian, Jesús López‐Herce, Andrea Christoff, Ryan W. Morgan, Arun Bansal, James M. Gray, Hiroshi Kurosawa, Leandra Rech, Joseph W. Rossano, Lokesh Kumar Tiwari, Michelle Christy Myburgh, Monica E. Kleinman, Ravi R. Thiagarajan, Stephan Katzenschlager, Tia Tortoriello Raymond, Anne‐Marie Guerguerian, Janice A. Tijssen, Gabrielle A. Nuthall, Steve M. Schexnayder, Thomaz Bittencourt Couto, Vinay Nadkarni, Yong-Kwang Gene Ong. Dianne Atkins, Allan deCaen · 发表于：Resuscitation Plus · 年份：2025 · DOI：10.1016/j.resplu.2025.101030 · 被引用次数：12 · 研究领域：Cardiac Arrest and Resuscitation、Mechanical Circulatory Support Devices、Cardiac Ischemia and Reperfusion

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:...