During resuscitation of a patient with ventricular fibrillation who has an implantable cardioverter-defibrillator, what is the recommended defibrillation approach?

• A. Apply hands-free adhesive patches in the anterior-posterior position and defibrillate.
• B. Remove the ICD and apply paddles to the chest.
• C. Deliver a DC shock using anterior-lateral pads.
• D. Initiate CPR for two minutes before delivering a shock.

Answer: (A)

When a patient with ventricular fibrillation has an implanted cardioverter-defibrillator, the goal is to deliver a life-saving shock while protecting the device. Using hands-free adhesive defibrillation patches placed in an anterior-posterior configuration keeps the energy vector away from the left chest where the ICD generator sits, reducing the chance of damaging the device and improving the chances the shock reaches the heart effectively. The ICD should remain in place during resuscitation; removing it isn’t part of acute care. Also, in ventricular fibrillation the shock should be delivered promptly rather than delaying for a prolonged CPR period first; CPR is performed in high-quality bursts between shocks rather than waiting to shock after a long delay.