To Shock or Not to Shock

The Management of Life-threatening Tachyarrhythmia in a Patient Fixed in the Mayfield Head Rest – To Shock or Not to Shock?

An event in clinical practice prompted consideration of the potential implications of DC cardioversion in a patient fixed in head pins, for instance, cervical spine injury, lacerations and burns.

An on-line survey through NASGBI indicated that events requiring CPR / DC cardioversion in such patients were not uncommon (10% of respondents) but that a large proportion of respondents (64%) had never considered how to manage such a scenario.

We believe that unconditional compliance with ALS guidelines for the treatment of tachydysrhythmia and cardiac arrest in this patient population can result in serious iatrogenic injury. We have devised a treatment algorithm to prompt clinicians to consider the potential of iatrogenic injury and also to suggest a logical approach to dealing with such patients.

The algorithm has been presented as a poster at the Resuscitation Council ASM 2010-and NASGBI ASM 2011 was received favorably at both venues.

We invite further comments.