Hands-on defibrillation with safety drapes: Analysis of compressions and an alternate current pathway.

BACKGROUND: Hands-on defibrillation (HOD) could theoretically improve the efficacy of cardiopulmonary resuscitation (CPR) though a few mechanisms. Polyethylene drapes could potentially facilitate safe HOD, but questions remain about the effects of CPR on polyethylene's conductance and the magnitude of current looping through rescuers' arms in contact with patients. METHODS: This study measured the leakage current through 2 mil (0.002 in.) polyethylene through two different current pathways before and after 30 min of continuous compressions on a CPR mannequin. The two pathways analyzed were the standardized IEC (International Electrotechnical Commission) leakage current analysis and a setup analyzing a current pathway looping through a rescuer's arms and returning to the patient. First, ten measurements involving the two pathways were obtained on a single polyethylene drape. 30 min of continuous compressions were applied to the drape on a CPR mannequin after which the ten measurements were repeated. RESULTS: Twenty patients undergoing elective cardioversion for atrial fibrillation (18/20) or atrial flutter (2/20) at Emory University Hospital underwent analysis all receiving 200 J shocks (age 38-101, 35% female). Through the IEC measurement method the peak leakage current mean was 0.70 +/- 0.02 mA before compressions and 0.59 +/- 0.19 mA after compressions. Only three of the ten measurements assessing current passing through a rescuer's arms had detectable current and each was of low magnitude. All measurements were well below the maximum IEC recommendations of 3.5 mA RMS and 5.0 mA peak. CONCLUSIONS: Polyethylene may facilitate safe HOD even after long durations of compressions. Current looping through a rescuer's arms is likely of insignificant magnitude.

The Reliability of a Novel Mobile 3-dimensional Wound Measurement Device.

BACKGROUND: Objective assessment of wound dimensions is essential for tracking progression and determining treatment effectiveness. A reliability study was designed to establish intrarater and interrater reliability of a novel mobile 3-dimensional wound measurement (3DWM) device. METHODS: Forty-five wounds were assessed by 2 raters using a 3DWM device to obtain length, width, area, depth, and volume measurements. Wounds were also measured manually, using a disposable ruler and digital planimetry. The intraclass correlation coefficient (ICC) was used to establish intrarater and interrater reliability. RESULTS: High levels of intrarater and interrater agreement were observed for area, length, and width; ICC = 0.998, 0.977, 0.955 and 0.999, 0.997, 0.995, respectively. Moderate levels of intrarater (ICC = 0.888) and interrater (ICC = 0.696) agreement were observed for volume. Lastly, depth yielded an intrarater ICC of 0.360 and an interrater ICC of 0.649. Measures from the 3DWM device were highly correlated with those obtained from scaled photography for length, width, and area (ρ = 0.997, 0.988, 0.997, P < 0.001). The 3DWM device yielded correlations of ρ = 0.990, 0.987, 0.996 with P < 0.001 for length, width, and area when compared to manual measurements. CONCLUSION: The 3DWM device was found to be highly reliable for measuring wound areas for a range of wound sizes and types as compared to manual measurement and digital planimetry. The depth and therefore volume measurement using the 3DWM device was found to have a lower ICC, but volume ICC alone was moderate. Overall, this device offers a mobile option for objective wound measurement in the clinical setting.