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. 2025 Oct:215:110730.
doi: 10.1016/j.resuscitation.2025.110730. Epub 2025 Jul 18.

Effect of manual pressure augmentation on transthoracic impedance: a real-time measurement during ventricular fibrillation in pigs and in healthy human volunteers

Aurora Magliocca  1 , Giulia Merigo  1 , Davide Zani  2 , Francesca Fumagalli  3 , Giuseppe Ristagno  4 ; UniMI-IRFMN Study Group
Collaborators, Affiliations

Effect of manual pressure augmentation on transthoracic impedance: a real-time measurement during ventricular fibrillation in pigs and in healthy human volunteers

Aurora Magliocca et al. Resuscitation. 2025 Oct.

Abstract

Manual pressure augmentation (MPA) during cardiopulmonary resuscitation involves applying downward force on defibrillatory pads during shock delivery to reduce transthoracic impedance (TTI) and enhance defibrillation success. This translational study is the first to directly and continuously measure the effect of MPA on TTI in a porcine ventricular fibrillation model and in healthy human volunteers. MPA significantly reduced TTI when pads were applied in the anterior-lateral position, with values remaining lower even after MPA release. These findings support the physiological rationale for MPA as a potential strategy to improve defibrillation efficacy, warranting further investigation into its clinical safety.

Keywords: Defibrillation; Humans; Manual pressure augmentation; Pigs; Transthoracic impedance.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘AM is YERC associate editor of Resuscitation Plus. GR is the ERC Director Congresses. All the other authors declared no conflicts.’.

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