A pacemaker is a small, implanted device designed to regulate the heart’s rhythm by delivering low-energy electrical impulses to maintain a steady heartbeat. Despite having a pacemaker, a person can still experience sudden cardiac arrest, making prompt intervention necessary. The immediate answer to whether you can perform cardiopulmonary resuscitation (CPR) on someone with a pacemaker is a definite yes. CPR should be initiated instantly if an individual is unresponsive and not breathing normally, as the benefits of circulating blood far outweigh any theoretical risk to the device.
The Necessity of Immediate Chest Compressions
When the heart stops beating effectively, the body enters cardiac arrest, requiring immediate mechanical assistance to circulate oxygenated blood. Delaying chest compressions significantly decreases the chance of survival because brain cells die quickly without oxygen. The priority is to keep blood flowing to the brain and other organs until professional help arrives. Standard guidelines for adult CPR require rescuers to push hard and fast on the center of the chest. This involves compressing the chest to a depth of at least two inches (five to six centimeters) at a rate of 100 to 120 compressions per minute. This standard procedure remains the same for a person with an implanted device, as the center of the chest is the target for maximum mechanical effect.
Adjusting Hand Placement for Device Safety
Pacemakers and implantable cardioverter-defibrillators (ICDs) are typically positioned just beneath the skin, often near the collarbone, usually on the upper left side of the chest. Before beginning compressions, the rescuer should quickly scan the chest area for a small lump or scar, which indicates the device’s location. This visual check allows for a minor but important adjustment to the compression technique.
The goal of the adjustment is to ensure the heel of the hand, which delivers the force of the compression, is placed directly over the center of the breastbone, or sternum. This central placement, which is the standard location for CPR, is naturally several inches away from the pacemaker’s typical implant site. By maintaining the correct hand position in the middle of the chest, rescuers avoid applying direct, repeated pressure to the pacemaker’s metal casing.
Avoiding direct force on the device minimizes the risk of physical damage to the pacemaker or its leads (the wires connecting the device to the heart muscle). While the device’s housing is durable, excessive, focused pressure could potentially cause internal damage or lead dislodgement. Therefore, the rescuer must focus on keeping their hands centered on the sternum, ensuring the life-sustaining force is delivered to the heart.
Using an Automated External Defibrillator (AED)
The use of an Automated External Defibrillator (AED) is a standard part of modern CPR protocol and is safe for individuals with pacemakers or ICDs. An AED delivers an electrical shock to reset the heart’s rhythm. The primary consideration when using an AED on a person with an implanted device is the placement of the electrode pads.
Rescuers must ensure that the AED pads are positioned several inches away from the pacemaker or ICD site. Placing an AED pad directly over the device could potentially damage the internal circuitry of the pacemaker or block the electrical current from reaching the heart muscle effectively. If the standard pad placement overlaps with the device, the rescuer should slightly shift the pad to an alternate location, such as using the anterior-posterior position, to maintain a safe distance.
The general rule is to keep the AED pads at least one inch, or about three centimeters, away from the visible bulge of the device. Following this guideline ensures the shock’s energy bypasses the implant, allowing the AED to analyze the heart rhythm and deliver a therapeutic electrical pulse when needed. The AED will not deliver a shock if a functional ICD has already restored a normal heart rhythm.