Manual pressure augmentation for defibrillation in cardiac arrest

Manual pressure augmentation (MPA) involves an operator wearing gloves pushing down on the sternal and apical patches at the time of energy delivery using either a clenched fist or open palm

A. Voskoboinik, Z. Nehme, P.M. Kistler, D. Stub, K. Smith, First Time Use of Manual Pressure Augmentation for Ventricular Fibrillation Arrest in the Community, Resuscitation (2022)

Potential effects of MPA

  • Reduction of transthoracic impedance
  • Improve emptying of the lungs, while shortening the distance between electrodes and ventricles
  • Improved delivery of current to the heart (this cannot be measured)
  • Reduced interruption of CPR by maintaining continuous chest compressions until energy delivery
  • Maintaintenance of an intra-thoracic to extra-thoracic pressure gradient

Numerous studies have recently reported on improved success rates for cardioversion of atrial fibrillation with application of additional pressure to the chest wall, either with paddles or manual pressure

AUGMENT-VA RCT will investigate MPA in OHCA

Resuscitation. DOI: