How should you manage a patient with a known pacemaker or ICD who requires CPR?

How should you manage a patient with a known pacemaker or ICD who requires CPR?

• A. Do not place defibrillator pads directly over the device; treat as standard resuscitation and reassess device function after
• B. Place defibrillator pads directly over the device
• C. Remove the device before resuscitation
• D. Deactivate the device during resuscitation

Answer: (A)

The key idea is protecting an implanted device while ensuring effective shock delivery during resuscitation. External defibrillation energy can interfere with or damage a pacemaker or ICD and may be directed through the device if a pad sits directly on it. To minimize this risk, do not place defibrillator pads directly over the device; position them so the energy travels through the chest without hitting the device, using standard pad placements as feasible around the device. Proceed with high-quality CPR and deliver shocks as indicated, without delaying care to reposition beyond what is necessary. After return of spontaneous circulation or stabilization, interrogate the device to assess function, lead integrity, and battery status, and adjust management if needed. Do not deactivate or remove the device during resuscitation; keep it in place and evaluate afterward.

The key idea is protecting an implanted device while ensuring effective shock delivery during resuscitation. External defibrillation energy can interfere with or damage a pacemaker or ICD and may be directed through the device if a pad sits directly on it. To minimize this risk, do not place defibrillator pads directly over the device; position them so the energy travels through the chest without hitting the device, using standard pad placements as feasible around the device. Proceed with high-quality CPR and deliver shocks as indicated, without delaying care to reposition beyond what is necessary. After return of spontaneous circulation or stabilization, interrogate the device to assess function, lead integrity, and battery status, and adjust management if needed. Do not deactivate or remove the device during resuscitation; keep it in place and evaluate afterward.