Resuscitation with ICD — EECC MCQ

Correct answer: B — CPR and external defibrillation should proceed as normal — an ICD does NOT change the standard resuscitation algorithm; pads should be placed at least 8 cm from the device; if the ICD is not delivering appropriate shocks, a magnet over the device activates shock delivery (for most ICDs)

Resuscitation of patients with CIEDs follows the same ALS algorithm with key additions: (1) external defibrillation: SAFE and indicated — place pads ≥8 cm from the pulse generator (anterior-posterior pad placement is preferred to minimise current through the device); do NOT delay defibrillation for any ICD-related reason; (2) CPR: standard technique — the device is subcutaneous and does not impede chest compressions; (3) ICD not firing: the device may not be sensing the arrhythmia (lead fracture, undersensing), may have reached shock limit, or the battery may be depleted; placing a magnet OVER the device suspends tachyarrhythmia detection for most ICDs (enabling external protocol) — however, in some older devices, a magnet may activate therapies; (4) post-resuscitation: urgent device interrogation to assess why the ICD did not deliver therapy.

Reference: ERC (2021): ALS Guidelines; BHRS ICD Guidance