ZOLL X Series User Manual

X Series® Operator’s Guide

9650-001355-01 Rev. H

The issue date for the X Series Operator's Guide (REF 9650-001355-01 Rev. H) is May, 2014.

0123

ZOLL Medical Corporation

269 Mill Road Chelmsford, MA USA 01824-4105

ZOLL International Holding B.V.

Newtonweg 18 6662 PV ELST The Netherlands

If more than 3 years have elapsed since the issue date, contact ZOLL Medical Corporation to det ermine if additional product information updates are available.

Copyright © 2014 ZOLL Medical Corporation. All rights reserved. CPR-D-padz, Pedi-padz, OneStep, Real CPR Help, Rectilinear Biphasic , RescueNet, See-Thru CPR, Stat-padz, SurePower, X Series, and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. All other trademarks are the property of their respective owners.

Masimo, Rainbow, SET, SpCO, and SpMet are trademarks or registered trademarks of Masimo Corporation in the United States and/or other countries.

IC Model: XSCP-1

Table of Content s

Ch a p t e r 1 General Information

Product Description ............................................................................................................1-1

X Series Optional Features .........................................................................................1-2

How to Use This Manual.....................................................................................................1-3

Operator’s Guide Updates..................................................................................................1-3

Unpacking...........................................................................................................................1-3

Symbols Used on the Equipment .......................................................................................1-4

Conventions........................................................................................................................1-7

X Series Indications for Use ...............................................................................................1-7

Manual Defibrillation ...................................................................................................1-8

Semiautomatic Operation (AED) ................................................................................1-8

ECG Monitoring ..........................................................................................................1-9

CPR Monitoring ..........................................................................................................1-9

External Transcutaneous Pacing ................................................................................1-9

Non-Invasive Blood Pressure Monitoring ...................................................................1-9

Temperature Monitoring .............................................................................................1-9

SpO

Monitoring .......................................................................................................1-10

Respiration Monitoring ..............................................................................................1-10

Monitoring .........................................................................................................1-10

Invasive Pressure Monitoring ...................................................................................1-10

12-Lead Analysis ......................................................................................................1-10

X Series Product Functions..............................................................................................1-11

Defibrillator Function .................................................................................................1-11

Defibrillator Output Energy .......................................................................................1-11

External Pacemaker .................................................................................................1-11

ECG Monitoring ........................................................................................................1-11

Electrodes .................................................................................................................1-12

Batteries ....................................................................................................................1-12

Ready For Use (RFU) Indicator ................................................................................1-13

Safety Considerations.......................................................................................................1-15

Warnings...........................................................................................................................1-15

General ..................................................................................................................... 1-15

ECG Monitoring ........................................................................................................1-16

Defibrillation .............................................................................................................. 1-17

Pacing ....................................................................................................................... 1-18

CPR ..........................................................................................................................1-19

Pulse Oximeter .........................................................................................................1-19

Noninvasive Blood Pressure .....................................................................................1-20

IBP ............................................................................................................................1-20

........................................................................................................................... 1-21

Respiration ................................................................................................................1-21

Ferromagnetic Equipment ........................................................................................1-21

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Battery ......................................................................................................................1-21

Operator Safety ........................................................................................................1-22

Patient Safety ...........................................................................................................1-23

Cautions............................................................................................................................1-24

Restarting the Defibrillator................................................................................................1-25

FDA Tracking Requirements.............................................................................................1-25

Notification of Adverse Events ..................................................................................1-26

Software License..............................................................................................................1-26

Service..............................................................................................................................1-27

The ZOLL Serial Number..................................................................................................1-28

Ch a p t e r 2 Product Overview

Defibrillator Controls and Indicators....................................................................................2-1

The Front Panel ..........................................................................................................2-2

Display Screen ............................................................................................................2-4

Battery Status and Auxiliary Power Indicators ............................................................2-6

Patient Cables and Connectors ..................................................................................2-7

External Paddles .......................................................................................................2-10

AC Auxiliary Power Adapter .....................................................................................2-13

DC Auxiliary Power Supply (optional) .......................................................................2-14

Connecting the DC Auxiliary Power Supply to a Suitable Vehicle Power Source ....2-14

Connecting AC Auxiliary Power Adapter or DC Auxiliary Power Supply to X Series

Unit ......................................................................................................................... 2-15

Navigating the Display Screen..........................................................................................2-15

Quick Access Keys ...................................................................................................2-16

Navigation Keys .......................................................................................................2-19

Display Brightness ....................................................................................................2-19

Common Tasks.................................................................................................................2-19

Changing the Display Brightness ..............................................................................2-19

Replacing a Battery Pack on the X Series ................................................................2-20

Using Treatment Buttons ..........................................................................................2-21

Ch a p t e r 3 Monitoring Overview

X Series Monitoring Functions............................................................................................3-1

ECG ............................................................................................................................3-2

Heart Rate ..................................................................................................................3-2

Respiration Rate .........................................................................................................3-2

Temperature ...............................................................................................................3-2

Invasive Pressures (IBP) ............................................................................................3-2

Non-Invasive Blood Pressure (NIBP) .........................................................................3-2

Capnography (CO

Pulse Oximetry (SpO

Monitoring Display Options.................................................................................................3-3

Configuring the Waveform Display.....................................................................................3-7

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) .................................................................................................... 3-3

) ...............................................................................................3-3

Chapter 4 Trends

Displaying the Trends Status Window ................................................................................4-1

Displaying and Printing Trend Information..........................................................................4-2

Changing the Trends Status Window Display.....................................................................4-3

Continuous Waveform Recording ...............................................................................4-3

Chapter 5 Alarms

Visual Alarm Indicators.......................................................................................................5-1

Audible Alarm Indicators.....................................................................................................5-2

Alarm Indicator Self-Test.....................................................................................................5-2

Patient Alarm Display .........................................................................................................5-3

Life Threatening Rhythm Alarms........................................................................................5-4

Equipment Alert Display .....................................................................................................5-4

Responding to Active Alarms -- Silencing the Alarm..........................................................5-5

Re-enabling an Alarm .................................................................................................5-5

Suspending Alarms.............................................................................................................5-5

The Alarm Suspension Timer .....................................................................................5-6

Alarm Options..................................................................................................................... 5-7

Selecting Default Alarm Limits ....................................................................................5-8

Setting Alarm Limits Relative to the Patient -- Stat Set Option ...................................5-8

Ch a p t e r 6 Monitoring ECG

ECG Monitoring Setup........................................................................................................6-2

Preparing the Patient for Electrode Application ..........................................................6-2

Applying Electrodes to the Patient ..............................................................................6-3

Connecting the ECG Cable To the X Series Unit .......................................................6-5

Selecting ECG Waveforms for Display .......................................................................6-6

Selecting the Waveform Trace Size ...........................................................................6-8

ECG Monitoring and Pacemakers......................................................................................6-9

ECG System Messages......................................................................................................6-9

Ch a p t e r 7 Monitoring Respiration (Resp) and Heart Rate (HR)

Respiration/Breath Rate Meter...........................................................................................7-2

Using Impedance Pneumography to Measure Respiration ........................................7-2

Configuring Respiration (RR/BR) Alarms and Settings ......................................................7-3

Enabling/Disabling RR/BR Alarms and Setting Alarm Limits ......................................7-3

Using the Resp Parameter Control Panel ...................................................................7-4

Heart Rate Meter........ .......... ........... .......... ........... ..............................................................7-5

Configuring Heart Rate (HR) Meter Alarms........................................................................7-5

Enabling/Disabling HR Alarms and Setting Alarm Limits ............................................7-6

Life Threatening Rhythm Alarms ................................................................................7-7

Using the Heart Rate Parameter Control Panel ..........................................................7-9

RESP System Message ...................................................................................................7-10

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Ch a p t e r 8 Monitoring Non-Invasive Blood Pressure (NIBP)

How does NIBP Work?.......................................................................................................8-2

The NIBP Numeric Display.................................................................................................8-3

NIBP Setup and Use...........................................................................................................8-3

Selecting the NIBP Cuff......................................................................................................8-4

Connecting the NIBP Cuff...................................................................................................8-5

Applying the Cuff to the Patient..........................................................................................8-7

Ensuring Correct Cuff Inflation Settings..............................................................................8-8

Configuring NIBP Alarms and Settings...............................................................................8-9

Enabling/Disabling NIBP Alarms and Setting Alarm Limits ........................................8-9

Using the NIBP Parameter Control Panel .................................................................8-11

NIBP System Messages...................................................................................................8-14

Ch a p t e r 9 Monitoring CO

Overview.............................................................................................................................9-1

Monitoring Setup and Use..........................................................................................9-2

Selecting the CO

Connecting the CO

Sampling Line ...............................................................................9-3

Sampling Lines ..........................................................................9-4

Applying a FilterLine Set .............................................................................................9-5

Applying a Smart CapnoLine Nasal or Nasal/Oral Cannula .......................................9-6

Measuring CO Setting CO

Enabling/Disabling Alarms and Setting CO

Using the CO CO

System Messages ....................................................................................................9-11

...................................................................................................................9-7

and Respiration Rate Alarms..........................................................................9-8

Alarm Limits ..........................................9-8

Parameter Control Panel ..................................................................9-10

Patents..............................................................................................................................9-12

Chapter 10 Pulse CO-Oximetry (SpO2, SPCO, and SpMet)

Warnings -- SpO2, General...............................................................................................10-2

Warnings -- SpO SpO

Setup and Use ........................................................................................................10-4

Selecting the SpO Applying the SpO

Applying a Two-Piece Single-Use Sensor/Cable ......................................................10-5

Applying a Reusable SpO

Cleaning and Reuse of Sensors ...............................................................................10-8

Connecting the SpO Displaying SpO Enabling/Disabling SpO

Setting Upper and Lower SpO

Setting Upper and Lower SpCO and SpMet Alarm Limits ......................................10-10

, Oximeter Sensor.................................................................................10-3

Sensor...............................................................................................10-4

Sensor................................................................................................10-4

Sensor/Cable ................................................................10-7

Sensor............................................................................................10-8

, SpCO, and SpMet Measurements........................................................10-8

Alarms and Setting Alarm Limits..............................................10-9

Alarm Limits ...........................................................10-9

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Using the SpO2 Parameter Control Panel ......................................................................10-10

Selecting the SpCO and SpMet Monitoring ............................................................10-10

Specifying the SpO

Selecting the SpO

Selecting the Heart Rate/ Pulse Rate (HR/PR) Tone .............................................10-11

SpO

System Messages................................................................................................. 10-11

Functional Testers and Patient Simulators .....................................................................10-13

Averaging Time .....................................................................10-11

Sensitivity ................................................................................10-11

Chapter 11 Monitoring Invasive Pressures (IBP)

Invasive Pressure Transducers........................................................................................ 11-1

IBP Setup..........................................................................................................................11-2

Attaching the Invasive Pressure Transducer ....................................................................11-2

Zeroing the Transducer.............................................................................................. .......11-3

Rezeroing a Transducer...................................................................................................11-4

Displaying IBP Measurements.......................................................................................... 11-5

Conditions Affecting IBP Measurements ..................................................................11-5

Enabling/Disabling IBP Alarms and Setting Alarm Limits.................................................11-6

Setting Upper and Lower Systolic (SYS) Alarm Limits .............................................11-6

Setting Upper and Lower Diastolic (DIA) Alarm Limits .............................................11-7

Setting Upper and Lower Mean Arterial Pressure (MEAN) Alarm Limits ..................11-7

Setting IBP Source Label ..........................................................................................11-8

IBP System Messages...................................................................................................... 11-9

Ch a p t e r 1 2 Monitoring Temperature

Temperature Monitoring Setup .........................................................................................12-1

Selecting and Applying Temperature Probes....................................................................12-1

Connecting the Temperature Probe..................................................................................12-2

Displaying Temperature....................................................................................................12-2

Enabling/Disabling Temperature Alarms and Setting Alarm Limits...................................12-3

Setting Upper and Lower Temperature Alarm Limits........................................................12-3

Setting Upper and Lower Temperature Alarm Limits........................................................12-4

Selecting the Temperature Label......................................................................................12-4

Temperature System Messages .......................................................................................12-5

Chapter 13 Automated External Defibrillator (AED) Operation

AED Operation..................................................................................................................13-2

Determine Patient Condition Following Medical Protocols .......................................13-2

Begin CPR Following Medical Protocols ..................................................................13-2

Prepare Patient .........................................................................................................13-3

1 Turn on unit ............................................................................................................13-3

2 Analyze ..................................................................................................................13-5

3 Press SHOCK ........................................................................................................13-7

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Operating Messages .................................................................................................13-8

Audio and Display Messages ...................................................................................13-8

Switching to Manual Mode Operation.............................................................................13-10

Chapter 14 12-Lead ECG Interpretive Analysis

Entering Patient Information.............................................................................................14-2

Entering the Patient Name and ID ............................................................................14-3

Entering Patient Age and Gender .............................................................................14-4

12-Lead ECG Monitoring Setup........................................................................................14-4

Preparing the Patient for Electrode Application ........................................................14-4

Applying Electrodes to the Patient ............................................................................14-5

Connecting the 12-Lead Cable .................................................................................14-7

Observing the 12-Lead Waveform Traces ................................................................14-8

12-Lead Interpretive Analysis ...................................................................................14-8

Fault Conditions Affecting 12-Lead Interpretive Analysis .......................................14-11

Printing 12-Lead Waveform Traces ................................................................................14-12

12-Lead Print and Display Options.................................................................................14-13

Selecting 12-Lead Acquire ......................................................................................14-14

Specifying the Number of 12-Lead Print Copies .....................................................14-14

Specifying the 12-Lead Print Format ......................................................................14-14

Printing 10 Seconds of the Lead ll Waveform Trace ..............................................14-14

Specifying the 12-Lead Frequency Response ........................................................14-14

Enabling 12-Lead Analysis .....................................................................................14-15

Chapter 15 Manual Defibrillation

Emergency Defibrillation Procedure with Paddles............................................................15-1

Determine the Patient’s Condition Following Local Medical Protocols ..................... 15-2

Begin CPR Following Local Medical Protocols .........................................................15-2

Turn On Unit .............................................................................................................15-2

1 Select Energy Level ...............................................................................................15-2

2 Charge Defibrillator ................................................................................................15-3

3 Deliver Shock .........................................................................................................15-5

Emergency Defibrillation Procedure with Hands-Free Therapy Electrodes......................15-6

Determine the Patient’s Condition Following Local Medical Protocols ..................... 15-6

Begin CPR Following Medical Protocols ..................................................................15-6

Prepare Patient .........................................................................................................15-6

Turn On Unit .............................................................................................................15-7

1 Select Energy Level ...............................................................................................15-7

2 Charge Defibrillator ................................................................................................15-8

3 Deliver Shock .........................................................................................................15-9

Internal Paddles................................................................................................................15-9

Verification Prior to Use ..........................................................................................15-10

Synchronized Cardioversion........................................................................................... 15-11

Synchronized Cardioversion Procedure.........................................................................15-12

Determine the Patient’s Condition and Provide Care Following Local Medical

Protocols ..............................................................................................................15-12

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Prepare Patient .......................................................................................................15-12

Turn On Unit ...........................................................................................................15-12

Press the Sync Key ................................................................................................15-12

1 Select Energy Level .............................................................................................15-13

2 Charge Defibrillator ..............................................................................................15-13

3 Deliver Shock .......................................................................................................15-14

Chapter 16 Advisory Defibrillation

Advisory Defibrillation Procedure......................................................................................16-2

Determine the Patient’s Condition Following Local Medical Protocols ..................... 16-2

Begin CPR Following Local Medical Protocols .........................................................16-2

Prepare Patient .........................................................................................................16-2

1 Turn on unit ............................................................................................................16-3

2 Press ANALYZE Button .........................................................................................16-4

3 Press SHOCK button .............................................................................................16-5

Ch a p t e r 1 7 Advisory/CPR Protocol Defibrillation

Advisory/CPR Protocol Defibrillation Procedure...............................................................17-2

Determine the Patient’s Condition Following Local Medical Protocols ..................... 17-2

Begin CPR Following Local Medical Protocols .........................................................17-2

Prepare Patient .........................................................................................................17-2

1 Turn on unit ............................................................................................................17-3

2 Press ANALYZE Button .........................................................................................17-4

3 Press SHOCK button .............................................................................................17-5

Chapter 18 External Pacing

External Pacing.................................................................................................................18-2

Pacer Modes .............................................................................................................18-2

Pacing in Demand Mode ..................................................................................................18-2

Determine Patient Condition and Provide Care Following Local Medical Protocols .18-2

Prepare the Patient ...................................................................................................18-2

1 Turn On Unit ..........................................................................................................18-2

2 Apply ECG Electrodes/Hands-Free Therapy Electrodes .......................................18-3

3 Press Pacer button ................................................................................................18-3

4 Set Mode ...............................................................................................................18-4

5 Set Pacer Rate ......................................................................................................18-4

6 Turn On Pacer .......................................................................................................18-4

7 Set Pacer Output ...................................................................................................18-4

8 Determine Capture ................................................................................................18-4

9 Determine Optimum Threshold ..............................................................................18-5

Pacing in Fixed Mode .......................................................................................................18-6

1 Turn On Unit ..........................................................................................................18-6

2 Apply ECG Electrodes/Hands-Free Therapy Electrodes .......................................18-6

3 Press Pacer button ................................................................................................18-7

4 Set Mode ...............................................................................................................18-7

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5 Set Pacer Rate ......................................................................................................18-7

6 Turn On Pacer .......................................................................................................18-7

7 Set Pacer Output ...................................................................................................18-7

8 Determine Capture ................................................................................................18-8

9 Determine Optimum Threshold ..............................................................................18-8

Pediatric Pacing ........................................................................................................18-9

Chapter 19 Real CPR Help

CPR Voice Prompts..........................................................................................................19-2

CPR Metronome...............................................................................................................19-2

CPR Dashboard................................................................................................................19-3

Rate and Depth Measurements ................................................................................19-3

CPR Release Indicator .............................................................................................19-3

Chest Compression Indicator ...................................................................................19-4

CPR Countdown Timer .............................................................................................19-4

CPR Idle Time Display ..............................................................................................19-4

FULLY RELEASE Prompt ........................................................................................19-5

CPR Compression Bar Graph ..........................................................................................19-5

Chapter 20 See-Thru CPR

Using See-Thru CPR........................................................................................................20-2

Examples .................................................................................................................. 20-2

Chapter 21 Patient Data

Storing Data......................................................................................................................21-1

Log Capacity Indicator ..............................................................................................21-2

Capturing a Data Snapshot...............................................................................................21-2

Reviewing and printing snapshots ............................................................................21-2

Treatment Summary Report.............................................................................................21-3

Printing Treatment Summary Report ........................................................................21-3

Transferring Data to a USB Device...................................................................................21-4

Clearing the Log .......................................................................................................21-4

Chapter 22 Wireless Communications

The Wireless Icon.............................................................................................................22-2

The Wireless Menu...........................................................................................................22-3

Creating a Temporary Access Point Profile ..............................................................22-3

Bluetooth Device Pairing ..........................................................................................22-8

Setting up Communications in the Supervisor Menu......................................................22-10

Setting up Wireless Profiles ....................................................................................22-10

WiFi Access Point Profiles ......................................................................................22-12

Setting up Cellular Communications .......................................................................22-18

Setting up an Ethernet Connection .........................................................................22-22

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Configuring Report Transmissions .........................................................................22-23

Sending a 12-lead report................................................................................................22-23

Communications System Messages...............................................................................22-25

Transmission Status of 12 Lead Snapshots....................................................................22-26

Chapter 23 Printing

Printing Patient Data.........................................................................................................23-1

Printer Setup .............................................................................................................23-2

Automatic Prints ........................................................................................................23-2

Printing Waveforms ..................................................................................................23-2

Printing Reports ...................................................................................... ........... .......23-3

Printing Trends ....................................................................................... ........... .......23-4

Chapter 24 Maintenance

Daily/Shift Check Procedure.............................................................................................24-2

Inspection .................................................................................................................24-2

Defibrillator/Pacing Test with Hands-Free Therapy Electrodes.........................................24-3

Defibrillator Testing with External Paddles........................................................................24-5

Recommended Minimum Preventive Maintenance Schedule..........................................24-7

Annually .................................................................................................................... 24-7

Guidelines for Maintaining Peak Battery Performance.....................................................24-7

Cleaning instructions ........................................................................................................24-8

Cleaning the X Series unit ........................................................................................24-8

Cleaning the NIBP Blood Pressure Cuff ...................................................................24-8

Cleaning SpO

Cleaning Cables and Accessories ............................................................................24-9

Loading Recorder Paper ...........................................................................................24-9

Cleaning the Print Head ..........................................................................................24-10

Sensors ............................................................................................24-9

Ap p e n d i x A Specifications

Defibrillator..........................................................................................................................A-2

Monitor/Display.................................................................................................................A-14

Impedance Pneumography...............................................................................................A-15

Alarms...............................................................................................................................A-16

Recorder...........................................................................................................................A-17

Battery ..............................................................................................................................A-17

General.............................................................................................................................A-18

Pacer ................................................................................................................................A-19

...................................................................................................................................A-19

Pulse Oximeter.................................................................................................................A-20

Non-Invasive Blood Pressure...........................................................................................A-22

Invasive Pressures ...........................................................................................................A-23

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Temperature......................................................................................................................A-24

Clinical Trial Results for the Biphasic Waveform ..............................................................A-25

Randomized Multicenter Clinical Trial for Defibrillation of Ventricular Fibrillation (VF)

and Ventricular Tachycardia (VT) ...........................................................................A-25

Randomized Multi-Center Clinical trial for Cardioversion of Atrial Fibrillation (AF) ...A-26

Synchronized Cardioversion of Atrial Fibrillation ......................................................A-28

Electromagnetic Compatibility Guidance and Manufacturer’s Declaration.......................A-29

Electromagnetic Immunity (IEC 60601-1-2) ..............................................................A-30

Electromagnetic Immunity: Life-Supporting Functions .............................................A-31

Electromagnetic Immunity: Non Life-Supporting Functions ......................................A-32

ECG Analysis Algorithm Accuracy....................................................................................A-35

Clinical Performance Results ....................................................................................A-35

Wireless Output Guidance and Manufacturer’s Declaration.............................................A-36

RF Transmission Emitted (IEC 60601-1-2) ...............................................................A-36

FCC Notice ...............................................................................................................A-36

Canada, Industry Canada (IC) Notices .....................................................................A-36

Appendix B Accessories

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Product Description

The ZOLL® X Series® unit is an easy-to-use portable defibrillator that combines defibrillati on and external pacing with the following monitoring capabilities: ECG, CO-Oximeter, Noninvasive Blood Pressure, IBP, CO

resuscitation situations and its rugged , compact, lightweight design makes it ideal for transport situations. It is powered by auxiliary power and an easily replaced battery pack that is quickly recharged in the device when it is connected to auxiliary power. In addition, the unit’s battery may be recharged and tested using a ZOLL SurePower™ Battery Charger Station.

Note: The X Series has defibrillation and pacing functionality, but some of the monitoring

functions are optional features. See the complete list of options in Fig. 1-1. All features are included in this manual, but only purchased features will be available on your unit.

The product is designed for use in both the hospital and the rugged EMS environment. The device is a versatile automated external defibrillator with manual capabilities and may be configured to operate in Manual, Advisory or Semiautomatic modes. It can be configured to start up in Semiautomatic (AED) mode or manual mode.

When operating in manual configuration, the device operates as a conventional defibrillator where the device’ s char ging and disc harging i s fully controlled by the operator. In Advisory and AED modes, some features of the device are automated and a sophisticated detection algorithm is used to identify ventricular fibrillation and determine the appropriateness of defibrillator shock delivery. Units may be configured to automatically charge, analyze, recharge, and prompt the operator to “PRESS SHOCK”, depending on local protocols. The unit is switched from AED mode to Manual mode for ACLS use by pressing the appropriate key on the front panel.

Chapter 1

General Information

, Temperature, and Respiration. It has been designed for all

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CHAPTER 1GENERAL INFORMATION

The X Series unit assists caregivers during cardiopulmonary resusc itatio n (CPR) by evaluat ing the rate and depth of chest compressions and providing feedback to the rescuer.

Real CPR Help® requires the use of ZOLL OneStep™ CPR electrodes, OneStep™ Complete electrodes, or CPR-D-padz adaptively filtered, using the See-Thru C PR

compressions. The unit has a large colorful LCD display of numerics and waveform data that provides easy

visibility from across the room and at any angle. ECG, plethysmograph, and respi ration waveform traces can be displayed simultaneously, giving easy access to all patient monitoring data at once. The display screen is configurable, so you can choose the best visual layout to fit your monitoring needs. The X Series includes a transcutaneous pacemaker consisting of a pulse generator and ECG sensing circuitry. Pacing supports both demand and fixed noninvasive pacing for adult patients and adolescent, child, and infant pediatric patients.

The X Series has a patient data review and collection system that allow s you to view, store, and transfer patient data. The X Series unit contains a printer and USB port, which you can use to print the data and transfer it to a PC.

The X Series unit can send data through a wireless connection to remote locations. The X Series unit can send 12-lead report snapshots (including trend data) to a recipient via a ZOLL server. Ful l disclosure case s, which also contai n trend data, can be automatically retrieved from the X Series unit using ZOLL RescueNet or ePCR software.

. When using these pads, the displayed ECG waveforms can be

feature, to reduce the artifact caused by chest

X Series Optional Features

The following features are optional in the X Series unit. Note: All features are included in this manual, but only purchased features will be avai lable

on your unit.

Figure 1-1 X Series Optional Features

Optional Feature

12-Lead ECG with Interpretation

(Masimo®) with SpCO® and SpMet

SpO

NIBP (with Smartcuf® and SureBPTM)

(Oridion® Microstream®)

EtCO

Temperature (2 Channels) Invasive Pressures (3 Channels) Advanced CPR Help Pacing Microphone

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How to Use This Manual

The X Series Operator's Guide provides information operators need for the safe and effective use and care of the X Series product. It is important that all persons using this device read and understand all the information contained within.

Please thoroughly read the safety considerations and warnings section. Procedures for daily checkout and unit care are located in the Chapter 24, "Maintenance".

Operator ’s Guide Updates

An issue or revision date for this manual is shown on the front cover. If more than three years have elapsed since this date, contact ZOLL Medical Corporation to determine if additional product information updates are available.

All users should carefully review each manual update to understand its significance and then file it in its appropriate section wi thin this manual for subsequent referenc e.

Product documentation is available through the ZOLL website at www.zoll.com. From the Products menu, choose Product Manuals.

Unpacking

How to Use This Manual

Carefully inspect each container for damage. If the shipping container or cushion material is damaged, keep it until the contents have been checked for completeness and the instrument has been checked for mechanical and electrical integrity. If the contents are incomplete, if there is mechanical damage, or if the defibrillator does n ot pass its electrical self-t est, U.S.A. customers should call ZOLL Medical Corporation (1-800-348-9011). Customers outside of the U.S.A. should contact the nearest ZOLL authorized representative. If the shipping container is damaged, also notify the carrier.

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CHAPTER 1GENERAL INFORMATION

Symbols Used on the Equipment

Any or all of the following symbols may be used in this manual or on this equipment:

Symbol Description

Class II equipment.

Dangerous voltage.

General warning: Observe and follow all safety signs.

Hot surface.

Fragile, handle with care.

Keep dry.

This end up.

Temperature limitation.

Conformité Européenne Complies with medical device directive 93/42/EEC.

Type B patient connection.

Type BF patient connection.

Type CF patient connection.

Defibrillator-proof type BF patient connection.

Defibrillator-proof type CF patient connection.

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Symbol Description

2%452.

,I)/.

RECYCLE

,I)/.

Fusible link.

Equipotentiality.

Alternating current (ac).

Direct current (dc).

Auxiliary power adapter operation.

Caution, high voltage.

Symbols Used on the Equipment

Earth (ground).

Negative input terminal.

Positive input terminal.

Power On/Off

Protective earth (ground).

Contains lithium. Recycle or dispose of properly.

Keep away from open flame and high heat.

Do not open, disassemble, or intentionally damage.

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CHAPTER 1GENERAL INFORMATION

Symbol Description

Do not crush.

Do not discard in trash. Recycle or dispose of properly.

Return to a collection site intended for waste electrical and electronic equipment (WEEE). Do not dispose of in unsorted trash.

Date of manufacture.

Use by.

Latex-free.

Do not reuse.

Do not fold.

Not sterile.

Manufacturer.

Authorized representative in the European Community.

Serial Number.

Catalogue number.

Consult instructions for use.

Refer to instruction manual/booklet.

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Symbol Description

Conventions

This guide uses the following conventions: Within text, the names and labels for physical buttons and softkeys appear in boldface type (for

example, “Press the Charge button or press the Pacer button”). This guide uses uppercase italics for audible prompts and for text messages displayed on the

screen (for example, LEAD FAULT).

Conventions

Prescription only.

Battery charging status.

Do not use device, cables, or probes in an MRI environment.

War ning ! Warning statements alert you to conditions or actions that can result in personal injury

or death.

Caution Caution statements alert you to conditions or actions that can result in damage to the unit.

X Series Indications for Use

The X Series is intended for use by trained medical personnel who are familiar with basic monitoring, vital sign assessment, emergency cardiac care, and the use of the X Series. The X Series is also intended for use by (or on the order of) physicians at the scene of an emergency or in a hospital emergency room, intensive care unit, cardiac care unit, or other similar areas of a hospital. The usage may be in an ambulance or at the scene of an emergency. It is also intended to be used during the transport of patients. The X Series will be used primarily on patients experiencing symptoms of cardiac arrest or in post trauma situation. It may also be used whenever it is required to monitor any of th ose functions that are included (as options) in the device. The X Series unit can be used on pediatric patients (as described in the following table) and on adult patients (21 years of age or older) with and without heart dysfunction.

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CHAPTER 1GENERAL INFORMATION

Pediatric Patient Subpopulation Approximate Age Range

Newborn (neonate) Birth to 1 month of age. Infant 1 month to 2 years of age. Child 2 to 12 years of age. Adolescent 12 to 21 years of age.

When the pediatric patient is less than 8 years of age or weighs less than 55 lbs. (25 kg.), use ZOLL Pedi-padz

pediatric defibrillation electrodes. Do not delay therapy to determine the

patient’s exact age or weight. AED mode and ALS rescue protocol are not intended for use on neonatal patients.

Manual Defibrillation

Use of the X Series in the manual mode for external and internal defibrillation is indicated on victims of cardiac arrest where there is apparent lack of circulation as indicated by:

• Unconsciousness.

• Absence of breathing.

• Absence of pulse.

This product should be used only by qualified medical personnel for converting ventricular fibrillation and rapid ventricular tachycardia to sinus rhythm or other cardiac rhythms capable of producing hemodynamically significant heart beats.

The unit can also be used for synchronized cardioversion of certain atrial or ventricular arrhythmias. Qualified medical personnel must decide when synchronized cardioversion is appropriate.

The patient population will range from newborn (neonate) to adult.

Semiautomatic Operation (AED)

X Series products are designed for use by emergency care personnel who have completed training and certification requirements applicable to the use of a defibrillator where the device operator controls delivery of shocks to the patient.

They are specifically designed for use in early defibrillation programs where the delivery of a defibrillator shock during resuscitation involving CPR, transportation, and definitive care are incorporated into a medically-approved patient care protocol.

Use of the X Series in the Semiautomatic mode for defibrillation is indicated on victims of cardiac arrest where there is apparent lack of circulation as indicated by:

• Unconsciousness.

• Absence of breathing.

• Absence of pulse.

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Specifications for the ECG rhythm analysis functi on are provided in the section “ECG Analysis Algorithm Accuracy” on page A-35.

When the patient is less than 8 years of age or weighs less that 55 lbs. (25 Kg), you must use ZOLL pediatric defibrillation electrodes. Do not de lay t herapy to det ermine pat ient’s exact age or weight.

ECG Monitoring

The X Series is intended for use to monitor and/or record 3-, 5-, or 12-lead ECG waveform and heart rate, and to alarm when heart rate is above or below limits set by the operator. The patient population will range from newborn (neonate) to adult, with and without heart dysfunction.

CPR Monitoring

The CPR monitoring function provides visual and audio feedback designed to encourage rescuers to perform chest compressions at the AHA/ERC recommended rate of 100 compressions per minute. Voice and visual prompts encourage a minimum compression depth of at least 1.5 (3.8 cm) or 2.0 inches (5.0 cm), depending on the configuration, for adult patients. The CPR monitoring function is not intended for use on patients under 8 years of age.

X Series Indications for Use

External Transcutaneous Pacing

This product can be used for temporary external cardiac pacing in conscious or unconscious patients as an alternative to endocardial stimulation.

The purposes of pacing include:

• Resuscitation from standstill or bradycardia of any etiology:

• As a standby when standstill or bradycardia might be expected:

• Suppression of tachycardia.

• Pediatric pacing.

Non-Invasive Blood Pressure Monitoring

The X Series is intended for use to make non-invasive measurements of arterial pressure and heart rate, and to alarm if either parameter is outside of the limits set by the user. Measurements are made using an inflatable cuff on the patient's arm or leg. The patient population will range from newborn (neonate) to adult.

Temperature Monitoring

The X Series is intended for use to make continuous temperature measurements of rectal, esophageal, or surface temperatures, and to alarm if the temperature is outside of the limits set by the user. The patient population will range from newborn (neonate) to adult.

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CHAPTER 1GENERAL INFORMATION

SpO2 Monitoring

The X Series pulse CO-oximeter, with Masimo Rainbow® SET technology and the Rainbow series of sensors, is intended for use for continuous noninvasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO

(SpCO), and/or methemoglobin saturation (SpMet). The pulse CO-oximeter and accessories are indicated for use on adult, pediatric, and neonatal patients during both no motion and motion conditions, and for patients who are well or poorly perfused, in hospitals, hospital-type facilities, or in mobile environments.

Respiration Monitoring

The X Series is intended for use to continuously monitor respiration ra te and to alarm if the rate falls outside of the range set by the operator. Because the measurement method actually measures respiratory effort, apnea episodes with continued respiratory effort (such as obstructive apnea) may not be detected. It is not intended to be used as an apnea monitor. The patient population will range from newborn (neonate) to adult.

CO2 Monitoring

), pulse rate, carboxyhemoglobin saturation

The X Series is intended for use to make cont inuo us nonin vasive measurem ent an d moni tori ng of carbon dioxide concentration of the expired and inspired breath and breath rate. The patient population will range from newborn (neonate) to adult.

Invasive Pressure Monitoring

The X Series is intended for use to display and make continuous invasive pressure measurements from any compatible pressure transducer. The primary intended uses are arterial blood pressure, central venous pressure and intracranial pressure monitoring. Any contraindications of the particular transducer selected by the user shall apply. The patient population will range from newborn (neonate) to adult.

12-Lead Analysis

The 12-lead ECG Analysis is intended for use in acquiring, analyzing and reporting ECG data, and to provide interpretation of the data for consideration by caregivers. The interpretations of ECG data offered by the device are only significant when used in conjunction with caregiver overread as well as consideration of all other relevant patient data. The 12-lead ECG Analysis is intended for use on adults (> 18 years of age).

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X Series Product Functions

Defibrillator Function

The X Series contains a direct current (dc) defibrillator capabl e of delivering up to 200 jo ules. It may be used in synchronized mode to perform synchronized cardioversion using the patient’s R-wave as a timing reference. The unit uses paddles or disposable, pregelled electrodes for defibrillation.

Defibrillator Output Energy

X Series defibrillators can deliver biphasic energy from 1 joule to 200 joules. The energy delivered through the chest wall, however, is determined by the patient’s transthoracic impedance. An adequate amount of e lectrolyte gel mu st be applied t o the paddles and a force of 10 to 12 kilograms (22 to 26.4 pounds) must be applied to each paddle in order to minimize this impedance. If hands-free therapy electrodes are used, make sure that they are properly applied. (Refer to the instructions on the electrode package).

X Series Product Functions

External Pacemaker

X Series defibrillators include a transcutaneous pacemaker consist in g of a pulse generator and ECG-sensing circuitry. Noninvasive transcutaneous pacing (NTP) is an established and proven technique. This therapy is easily and rapidly applied in both emergency and nonemergency situations when temporary cardiac stimulation is indicated.

The output current of the pacemaker is continuously variable from 10 to 140 mA (the output current is 0 mA when paused). The rate is continuously variable from 30 to 180 pulses per minute (ppm), by increments of 5 ppm (10 bpm when greater than 100 ppm).

The pacing output pulse is delivered to the heart via ZOLL hands-free defibrillation/pacing electrodes placed on the patient’s back and the precordium.

Proper operation of the device, together with correct electrode placeme nt, is critical to obtaining optimal results. Every operator must be thoroughly familiar with these operating instructions.

ECG Monitoring

The patient’s ECG is monitored by connecting the patient to the unit via a 3-, 5-, or 12-lead patient cable or hands-free therapy electrodes. The ECG waveform is presented on the display along with the following information:

• averaged heart rate, derived by measuring R to R intervals

• lead selection - I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6 (with ECG cable),

PADDLES, or PADS.

• ECG size - 0.125, 0.25, 0.50, 1.0, 2.0, 4.0 cm/mV, AUTO

• status messages

The ECG bandwidth is user selectable.

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CHAPTER 1GENERAL INFORMATION

Electrodes

The X Series units will defibrillate, cardiovert, and monitor ECG using hands-free therapy electrodes. The X Series unit will pace using ZOLL hands-free therapy electrodes.

Energy Select, Charge and Shock controls are located on the paddles and front panel. When using hands-free therapy electrodes, you must use the controls on the front panel of the unit. To switch between paddles and hands-free therapy electrodes, remove the multifunction cable (MFC or OneStep) from the apex paddle and connect the hands-free therapy electrodes to the cable.

You should always check the expiration date on the electrode packaging. Do not use expired electrodes, which might result in false patient impedance readings and affect the level of delivered energy, or cause burns.

This symbol on the electrode package is accompanied by the expiration date. For Stat-padz

lower right corner of the label, below the lot number.

Note: ZOLL electrodes contain no hazardous materials and may be disposed of in general

trash unless contaminated with pathogens. Use appropriate precautions when disposing of contaminated electrodes.

When the patient is less than 8 years old or weighs less than 55 lb. (25 kg), use ZOLL OneStep Pediatric defibrillation electrodes. Do not delay therapy to determine the patient’s exact age or weight.

II, this symbol does not appear; the expiration date appears on the

Batteries

X Series models use an easily replaced rechargeable li thium-ion battery pack (the Su r ePower II Battery Pack). A new, fully charged battery pack typically delivers more than 6 hours of ECG monitoring. Use of other functions (such as the defibrillator, printer, or pacemaker) reduces this time.

When a LOW BATTERY icon appears on the display and the unit emits three beeps in conjunction with the displayed battery icon, the battery must be replaced and recharged.

You can charge the battery by either of the following methods:

• Internal charging — plug the X Series into an auxiliary power adapter to automatically

begin charging the installed battery pack. The front panel battery indicator operates as follows:

When the indicator is: It means:

Steady yellow Battery is charging. Steady green Battery is charged. Alternating yellow and

green

Not lit No battery in device.

The charge state cannot be determined or a battery charging fault has been detected.

Note: Upon power up, it takes approximately 45 seconds for the LEDs on the battery to

accurately display run time.

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• External charging — use the ZOLL SurePower Battery Charger with the X Series battery

adapter to charge the battery pack and test the battery’s capacity. For details, refer to the SurePower II Battery Pack Guide.

The Recalibration LED icon ( ) lights for approximately 10 seconds (after you press and release the Display button) if the battery ne eds to be calibrated . If the Recalibration LED lights, the runtime indicator will not display run time for that battery. For best performance of the battery, you should recalibrate the battery as soon as possible.

To manually recalibrate the SurePower II Battery Pack, you can insert the battery into the SurePower Charger Station and perform a Manual Test (for mo re information, see the ZOLL SurePower Charger Station Operator’s Guide).

After you recalibrate the battery, the Recalibration LED will only flash when you press the Display button.

Ready For Use (RFU) Indicator

The X Series has an RFU indicator on the front panel that indicates if the device is ready for use. The RFU indicator has three states which are described in the following table.

State Description Action

X Series Product Functions

Ready for Use The device is ready for use. Patient

monitoring, defibrillation, and pacing parameters are functional and the battery is above the low battery capacity.

Note: If the device is plugged into the auxiliary power adapter, the Ready for Use indicator may display even if the battery is depleted. Check the status of the battery before removing the device from the auxiliary power adapter.

None required.

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CHAPTER 1GENERAL INFORMATION

State Description Action

Flashing One or more of the following has

occurred:

• The battery is not properly installed.

• A low battery is installed.

• A battery fault has occurred.

• There is no battery installed

while connected to auxiliary power.

• One or more patient monitoring parameters have failed self-test (NIBP, SpO

Temp).

• The front panel button self-test failed.

• The speech database self-test failed.

Do Not Use One or more of the following has

occurred:

• The battery is not properly installed.

• No battery is installed and auxiliary power is not present.

• A very low battery (below software shutdown limit) was installed.

• ECG, defibrillator, or pacer selftests have failed, or other critical self-tests have failed.

, CO2, IBP, or

Install a fully charged battery in the unit and check the RFU indicator again. If the RFU indicator continues to flash, remove the unit from service and contact the appropriate technical personnel or the ZOLL Technical Service Department.

Install a fully charged battery in the unit and check the RFU indicator again. If the RFU indicator continues to display the Do Not Use symbol, remove the unit from service and contact the appropriate technical personnel or the ZOLL Technical Service Department.

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Safety Considerations

All operators should review these safety considerations before using the X Series unit. X Series units are high-energy defibrillators capable of delivering 200 joules. To completely

deactivate the unit, press the power switch to turn the unit off. To manually disarm a charged (or charging) defibrillator, do one of the following:

• Press the Disarm quick access key .

• Change the selected energy.

• Press the power switch to turn the unit off.

For safety, the X Series automatically disarms if left charged for more than 60 seconds if the shock button ( ) is not pressed.

Warnings

General

Federal (U.S.A.) law restricts this defibrillator to sale by or on the order of a physician.

Safety Considerations

Only appropriately trained, skilled personnel who are familiar with equipment operation should perform emergency defibrillation. The prescribing physician should determine what training, such as Advanced Cardiac Life Support (ACLS) or Basic Life Support (BLS) certification, is appropriate.

Only skilled personnel trained in Advanced Cardiac Life Support (ACLS) and who are familiar with equipment operation should perform synchronized cardioversion. The precise cardiac arrhythmia must be determined before attempting defi bril lat io n.

These operating instructions describe the functions and proper operation of the X Series products. They are not a substitute for a formal patient care training course. Operators should obtain formal training from an appropriate authority before using this defibrillator for patient care.

Proper operation of the unit and correct electrode placement is critical to obtaining optimal results. Operators must be thoroughly familiar with proper device operation.

The use of external pacing/defibrillation electrodes, accessories, or adapter devices from sources other than ZOLL is not recommended. ZOLL makes no representations or warranties regarding the performance or effectiveness of its products when used with pacing/defibrillation electrodes or adapter devices from other sources. Defibrillator failures attributable to the use of pacing/defibrillation electrodes or adapters not manufactured by ZOLL might void ZOLL’s warranty.

At receipt of shipment, check pacing/defibrillation electrodes to ensure compatibility. Allow ample slack in cables to make sure that cables do not tug at electrodes. Do not disassemble the unit. A shock hazard exists. Refer all problems to authorized service

personnel. Follow all recommended maintenance instructions. If a problem occurs, obtain service

immediately. Do not use the defibrillator until it has been inspected by appropriate personnel.

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CHAPTER 1GENERAL INFORMATION

The X Series unit might not perform to specifications when stored at the upper or lower extreme limits of storage temperature and then immediately put into use. The X Series unit should not be stored or used outside of the environmental limits p rovided in Appendix A of this manual.

A void using the X Series adjacent to, or stacked on, other equipment. If unavoidable, verify that the unit operates normally in this configuration before clinical use.

The X Series unit should be installed and put in to service a ccordi ng to the EM C informati on in Appendix A of this manual.

Do not use internal paddles while the X Series unit’s auxiliary power source is connected to an aircraft AC power operating at a frequency of 400 Hz.

The use of accessories, transducers, and cables other than those specified in this manual and related X Series option manual inserts may result in increased emissions or decreased immunity of the X Series.

Perform functional test of internal paddles prior to use. Do not use or place the unit in service if the Ready For Use indicator (at the upper right of the

front panel) displays a red circle with a line through it. Carefully route patient cabl es to avoid tri pping over the m, or inadverte ntly pulli ng the unit onto

the patient. Always inspect the unit for damage if it has been dropped. Only authorized personnel should use the Supervisor menus. If uncertain about the accuracy of any measurement, first check the patient’s vital signs by

alternate means, and then make sure the monitor is functioning correctly.

ECG Monitoring

Implanted pacemakers might cause the heart rate meter to count the pacemaker rate during incidents of cardiac arrest or other arrhythmias. Dedicated pacemaker detection circuitry may not detect all implanted pacemaker spikes. Check the patient's pulse; do not rely solely on heart rate meters. Patient history and physical examination are important factors in determining the presence of an implanted pacemaker. Pacemaker patients should be carefully observed. See “Pacemaker Pulse Rejection:” on page A-15 of this manual for disclosure of the pacemaker pulse rejection capability of this instrument.

Use only ECG electrodes that meet the AAMI standard for electrode performance (AAMI EC-12). Use of electrodes not meeting this AAMI standard could cause the ECG tr ace recovery after defibrillation to be significantly delayed.

Prior to attempting synchronized cardioversion, ensure the ECG signal quality is good and that sync markers are displayed above each QRS complex.

Do not place electrodes directly over an implanted pacemaker. The X Series unit detects ECG electrical signals only. It does not detect a pulse (effective

circulatory perfusion). Always verify pulse and heart rate by physical assessment of the patient. Never assume that the display of a nonzero heart rate means that the pat ient has a pulse.

Excessive artifact can result due to improper skin preparation of th e electrode site s. Follow skin preparation instructions in Chapter 6: “Monitoring ECG.”

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Equipment such as electrocautery or diathermy equipment, RFID readers, electronic art icle surveillance (EAS) systems, or metal detectors that emit strong radio frequency signals can cause electrical interference and distort the ECG signal displayed by the monitor, thereby preventing accurate rhythm analysis. Ensure adequate separation between such emitters, the device, and the patient when performing rhythm analysis.

Shock Hazard: Use of accessories, other than those specified in the operating instructions, may adversely affect patient leakage currents.

Certain line-isolation monitors may cause interference on the ECG display and may inhibit heart rate alarms.

Monitoring ECG through the paddles may result in inaccurate heart rate display due to artifact.

Defibrillation

The ZOLL X Series can deliver 200 joules o f electrical energy. If this electrical energy is not discharged properly, as described in the this manual, the electrical energy could cause persona l injury or death to the operator or bystander.

To avoid possible damage to the X Series unit, turn off pacing before defibrillating the patient with a second defibrillator.

Warnings

After a synchronized cardioversion, the SYNC mode may be cleared after each shock or disarm. The user may have to reselect (press) the SYNC button after each synchronized cardioversion shock performed on a patient. In Defib/Pacer Default sett ings in the Supervisor Setup menu, the X Series can be configured to remain in the SYNC mode after each synchronized cardioversion.

Synchronized cardioversion can be performed in the paddle monitoring mode. However, it is possible that artifact can be produced by the moving paddles, which could cause t he defibrillator to trigger on the artifact. It is recommended that monitoring in leads I, II or III be used during synchronized cardioversion. Paddle monitoring should not be used for elective cardioversions procedures.

To avoid stress to the defibrillator or the tester, never attempt to repeatedly charge and discharge the defibrillator in rapid succession. If a need for repetitive testing arises, allow a waiting period of at least 2 minutes after every third discharge.

In the SYNC mode, the defibrillator does not discharge without a command signal (R-w ave detection) from the ECG monitor indicate d by a SYNC marker on the trace and a flashing SYNC indicator.

If conductive gel forms a continuous path between the defibrillator electrodes, delivered energy may be dramatically reduced to zero. In this case, reposition the electrodes to eliminate the shunting path before attempting additional shocks.

Improper defibrillation technique can cause skin burns. To limit possible skin burns, use only ZOLL defibrillation gel on paddles, ensure the gel covers the entire paddle surface and press firmly against patient’s chest.

If a new energy level is selected after the CHARGE button is pushed and while the defibrillator is charging or charged, the defibrillator will disarm. The CHARGE button will need to be pressed again to charge to the new energy level.

Prior to defibrillation, disconnect from the patient any medical electronic device that is not labeled “defibrillation protected.”

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CHAPTER 1GENERAL INFORMATION

Before charging the defibrillator, verify that the energy selected on the display is the desired output.

Defibrillation takes priority over external pacing. Should the defibrillator be charged during the administration of external pacing, the pacer turns off and the defibrillator charges to the selected energy.

Pacing

Ventricular fibrillation does not respond to pacing and requires immediate defibrillation. Therefore, the patient’s dysrhythmia must be determined immediately, so that you can employ appropriate therapy . If t he patient is in ventricula r fibrillation and defibrilla tion is successful but cardiac standstill (asystole) ensues, you should use the pacemaker.

Ventricular or supraventricular tachycardias can be interrupted with pacing, but in an emergency or during circulatory collapse, synchronized cardioversion is faster and more certain.

Pulseless electrical activity (PEA) can occur following prolonged cardiac arrest or in other disease states with myocardial depression. Pacing might then produce ECG responses wi th out effective mechanical contractions, making other effective treatment necessary.

Pacing can evoke undesirable repetitive resp onses, tachycardia, or fibrillation in the presence of generalized hypoxia, myocardial ischemia, cardiac drug toxicity, electrolyte imbalance, or other cardiac diseases.

Pacing by any method tends to inhibit intrinsic rhythmicity. Abrupt cessation of pacing, particularly at rapid rates, can cause ventricular standstill and should be avoided.

Noninvasive temporary pacing can cause discomfort of varying intensity, which occasionally can be severe and preclude its continued use in conscious patients.

Similarly, unavoidable skeletal muscle contraction might be troublesome in very sick patients and might limit continuous use to a few hours. Erythema or hyperemia of the skin under the hands-free therapy electrodes often occurs; this effect is usually enhanced along the perimeter of the electrode. This reddening should lessen substantially withi n 72 hours.

There have been reports of burns under the anterior electrode when pacing adult patients with severely restricted blood flow to the skin. Prolonged pacing should be avoided in these cases and periodic inspection of the underlying skin is advised.

There are reports of transient inhibition of spontaneous respiration in unconscious patients with previously available units when the anterior electrode was placed too low on the abdomen.

The pacing rate determination can be adversely affected by artifact. If the patient’s pulse and the heart rate display are sig nificantly different, external pacing pulses may not be delivered when required.

Artifact and ECG noise can make R-wave detection unreliable, affecting the HR meter and the demand mode pacing rate. Always observe the patient closely during pacing operations. Consider using asynchronous pacing mode if a reliable ECG trace is unob tai nab le .

Transcutaneous pacing should not be used to treat V FIB (ventricular fibrillation). In cases of V FIB, immediate defibrillation is advised.

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