Hands-on defibrillation: How well would medical examination gloves protect rescuers from defibrillation voltages?

Abstract

Purpose: Hands-on defibrillation can reduce pauses in chest compressions during CPR, but how safe is it? Common biphasic defibrillation shocks range from 1400 to 2800 V; monophasic defibrillators can go to 5000 V. Safety of a rescuer contacting the patient during these shocks is determined by (1) the fraction of the shock voltage presented to the rescuer, and (2) the breakdown voltage of the rescuer's gloves. Neither has been adequately investigated. We determined the electrical breakdown voltage for medical examination gloves. Methods: We used a dielectric analyzer to apply an increasing voltage ramp to each glove until an electrical arc occurred, current flow exceeded a pre-defined limit, or 5000 V was reached. Four glove polymers were tested in single-layer and double-layer configurations with current limits of 0.1 mA (based on existing leakage current standards) or 10 mA (threshold for glove breakdown and significant injury potential) for a total of 320 measurements. Results:Tabled 1Glove breakdown voltages minimum, median, nPolymerSingle layerDouble layer0.1mA10mA0.1 mALatex3000 V, 5000 V, 402502 V, 4252 V, 20–Chloroprene2250 V, 2986 V, 402998 V, 3321 V, 20–Nitrile811 V, 1575 V, 401745 V, 3221 V, 202092 V, 2453 V, 40Vinyl604 V, 972 V, 401873 V, 3995 V, 20789 V, 965 V, 40 Open table in a new tab Of the single gloves tested, 0% latex, 29% chloroprene, 100% nitrile and 100% vinyl gloves exceeded leakage current standards at or below 2800 V. In addition, 10% latex, 0% chloroprene, 8% nitrile, and 8% vinyl gloves permitted current levels that could allow significant rescuer injury. Conclusions: The voltages at which leakage current standards were exceeded or electrical breakdown occurred varied considerably between glove types. The other factor affecting safety, the fraction of shock voltage presented to the rescuer, may be difficult to assess. Until this fraction is firmly established it may be prudent to use gloves designed to withstand the maximum defibrillator output voltage.