Defibrillation ( Manual ) of Adults by Suitably Qualified Medical Staff - ZOLL M or R Series

Publication: 19/01/2009  --
Last review: 25/03/2019  
Next review: 01/03/2022  
Clinical Guideline
ID: 1473 
Approved By: Clinical Guidelines Committee 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

ZOLL M or R Series
Manual Defibrillation Of Adults by Suitably Qualified Healthcare Professionals

1. Manual Defibrillation - Clinical Guidance
1.1 Summary
1.2 Definition
1.3 Indications for use
1.4 Guidelines
1.4.1 Procedure
1.5 Training and implementation plan
1.6 Review
1.7 References

1. Manual Defibrillation - Clinical Guidance

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1.1 Summary

Following the onset of ventricular fibrillation / pulseless ventricular tachycardia (VF / VT), cardiac output ceases and cerebral hypoxia injury starts within 3 minutes. If complete neurological recovery is to be achieved, early successful defibrillation with a return of spontaneous circulation is needed. Early defibrillation has been proven to improve outcome from VF / VT cardiac arrest. The probability of successful defibrillation and subsequent survival to hospital discharge declines rapidly with time and the ability to deliver early defibrillation is one of the most important factors in determining survival from cardiac arrest.

Manual defibrillators permit maximum flexibility and speed of operation. However they require that operators are competent in rhythm recognition skills and current resuscitation protocols. Staff not possessing these skills, are referred to the clinical guideline on automated defibrillation.

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1.2 Definition

Defibrillation is the passage of current of sufficient magnitude across the myocardium to depolarise a critical mass of the cardiac muscle simultaneously, enabling the natural pacemaker tissue to resume control.

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1.3 Indication for use

For use in adult patients who are unresponsive, apnoeic, and pulseless and displaying the arrhythmia of ventricular fibrillation or pulseless ventricular tachycardia.

For use by any Leeds Teaching Hospitals NHS Trust employee who fulfils the criteria outlined in the Resuscitation Departments Training and Education policy.
Operators should practice within the boundaries outlined within this document.

Manual defibrillation should be undertaken by staff members who have had the relevant training e.g. ALS, in house training by the resuscitation team or ALS instructors or in specific locations where manual defibrillation is used routinely. If staff have not been appropriately trained in manual defibrillation, an AED should be used.

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1.4 Guidelines

These guidelines have been produced to support the use of manual defibrillators with hands free pads on an adult diagnosed by the operator as being in cardiac arrest and the presenting rhythm is either ventricular fibrillation or pulseless ventricular tachycardia.

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1.4.1 Procedure

Upon discovering a collapsed person the following sequence of events should occur:



1. Ensure the area is safe

Safety of the rescuer is paramount.
The rescuer must not endanger their own life

2. Shake the victim gently by his shoulders and ask loudly ‘are you all right’

This will determine if the victim is responsive

3. If the person is unresponsive either:
a) Pull the emergency bell located in some hospital areas
b) Shout for help

Summoning help quickly to fulfil subsequent tasks e.g. calling 2222 and bringing the cardiac arrest trolley to the victim.

4. Turn the victim on his back. Open the airway by tilting the
head and lifting the chin.

Avoid head tilt if injury to the neck is suspected

This will hopefully achieve a patent airway for the victim and allow further assessment.

Head tilt may worsen a neck injury. Instead chin lift only or use jaw thrust.

5. Listen for any breath sounds at the victims mouth, feel for any warmth of expired air on your cheek.
At the same time attempt to feel for a carotid pulse. Assessment of breathing and circulation should take no more than 10 seconds.

This is abnormal breathing and should be treated as if the person is not breathing at all.

It is recognised that locating a carotid pulse can be difficult. If any doubt exists as to the presence of a circulation and no breathing is apparent then commence chest compressions

6. If there are no signs of life

Send an assistant to summon the cardiac arrest team by dialling 2222. Ask the assistant to return with the cardiac arrest trolley and defibrillator whilst chest compressions are commenced.
If you are on your own leave the victim to call 2222 returning to the patient with the cardiac arrest trolley and defibrillator

To ensure the cardiac arrest team arrives as soon as possible

Defibrillation may reverse the cause of the arrest. Cardiac compressions alone will not reverse the arrest but simply buys time until advanced interventions can be applied.

7. Immediately the defibrillator arrives it should be attached to the victim via the single use defibrillator pads. This is performed by placing one beneath the right clavicle, to the right of the sternum and the other in the left mid-axillary line

If more than one rescuer is present chest compressions should be continued whilst the defibrillator pads are attached

To enable a quick and accurate assessment of the patients rhythm, and if required, to enable defibrillation to occur without delay.
Pictures on the pads allow correct placement of pads. Each pad MUST be placed onto the victims bare chest

Interruptions to chest compressions should be kept to a minimum to maximise blood flow to the heart

8. Plan actions before pausing CPR for rhythm analysis and communicate these to the team

Team and patient safety

9. Stop chest compressions; confirm shockable rhythm (VF/pVT)

Identify rhythm to deliver correct treatment

10. Shockable rhythm identified - resume chest compressions immediately.
Simultaneously, the designated person ensures correct energy is selected (120J) and presses the charge button.

Zoll M and R series defibrillators use the following energy levels
120J, 150J, 200J.
Energy in both models self-increment

11. While the defibrillator is charging, warn all staff other than the individual performing chest compressions to “stand clear” and remove any oxygen delivery device as appropriate. Ensure that the person performing chest compressions is the only person touching the patient.

Minimise interruptions to chest compressions

12. Once the defibrillator is charged, tell the person doing the chest compressions to “stand clear”, when clear, deliver the shock


13. Without reassessing the rhythm or feeling the pulse restart CPR using a ratio of 30:2, starting with chest compressions.
Continue CPR for 2 minutes

Minimise interruptions to chest compressions

14. Pause compressions briefly after 2 minutes to check the rhythm

No longer than 5 seconds

15. If VF/pVT persists, repeat steps 9 -13 and deliver a second shock at 150J


16. Following a further 2 minutes of high quality CPR, briefly reassess the rhythm


17. If VF/pVT persists, repeat steps 9 -13 and deliver a third shock at 200J


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1.5 Training and implementation plan

All training will be provided or facilitated by Resuscitation Services on an Advanced Life Support Course (ALS) or in house training.

All staff are responsible for maintaining and updating their skills in the use of a manual defibrillator.

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1.6 Review

These guidelines will be reviewed with the introduction of the next planned Resuscitation Council (UK) guideline review in October 2020 or such time before that, should new national guidelines be produced.


Record: 1473

These guidelines have been produced to support the use of manual defibrillators with external paddles or hands free pads on an adult diagnosed by the operator as being in cardiac arrest and the presenting rhythm is either ventricular fibrillation or pulseless ventricular tachycardia.

Clinical condition:

Adults in cardiopulmonary arrest and in either Ventricular Fibrillation or Pulse-less Ventricular Tachycardia

Target patient group: All adults
Target professional group(s): Allied Health Professionals
Secondary Care Nurses
Secondary Care Doctors
Adapted from:

Evidence base

1.7 References

Adult Resuscitation Guidelines 2015. London. Resuscitation Council (UK)

Resuscitation Council (UK). 2015. Advanced Life Support Course Provider

Manual. Sixth Edition. Resuscitation Council (UK).

Approved By

Clinical Guidelines Committee

Document history

LHP version 1.0

Related information

Not supplied

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