Is CPR performed any differently if patient has a defibrillator?

CPR should not be performed differently if a patient has an implantable cardioverter defibrillator (ICD), as there is no evidence that doing so improves outcomes or reduces the risk of complications.

The presence of an ICD does not interfere with the efficacy of CPR because the defibrillator is implanted in the left ventricle of the heart, while CPR focuses on chest compressions of the sternum over the heart. The automated external defibrillator (AED) pads are placed on the patient's chest in a specific configuration that avoids interference with the ICD.

Here are some important considerations when performing CPR on a patient with an ICD:

- Identify the presence of an ICD: Look for a raised area or bulge under the skin, typically on the left side of the chest. The ICD may be visible or palpable and may be accompanied by a visible scar.

- Do not touch or press on the ICD: It is important to avoid direct pressure or manipulation of the ICD during CPR to prevent it from delivering inappropriate shocks or causing damage.

- Place AED pads according to guidelines: Follow the AED instructions to place the pads in the appropriate locations on the chest, as recommended by the manufacturer and according to current CPR guidelines. Modern AEDs have sophisticated algorithms that automatically detect and adjust to the presence of an ICD.

- Continue CPR as normal: Perform CPR according to the recommended guidelines, including chest compressions, rescue breaths (if trained and appropriate), and use of the AED if indicated. The AED will analyze the patient's heart rhythm and determine whether a shock is necessary, regardless of the presence of the ICD.

- If the ICD delivers a shock: If the ICD delivers a shock during CPR, pause chest compressions briefly until the shock is complete and then resume CPR as soon as possible.

Effective communication with healthcare professionals is crucial when performing CPR on a patient with an ICD, as they may provide additional guidance based on the specific type of ICD and the patient's condition.