# Effect of patient clothing removal with scissors on time to defibrillation by lay rescuers: a randomized controlled simulation trial

## TL;DR

Using scissors to remove a patient's clothing during a simulated cardiac arrest scenario delayed defibrillation time without improving AED pad placement accuracy.

## Contribution

This study is the first to show that using scissors for clothing removal by lay rescuers slows down defibrillation time in a controlled simulation.

## Key findings

- Using scissors increased the median time to defibrillation by 24 seconds compared to not using scissors.
- AED pad placement accuracy was not significantly improved with the use of scissors.
- Correct pad placement rates were low overall, with only 10% accuracy for the anterior pad and 55% for the lateral pad.

## Abstract

Early defibrillation using an automated external defibrillator (AED) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA). However, the impact of clothing removal strategies on time to defibrillation and AED pad placement accuracy remains unclear.

We conducted a prospective, randomized controlled simulation trial involving 40 undergraduate students without healthcare provider–level resuscitation training. Participants were randomly assigned (1:1) to the scissors or no-scissors group during a simulated OHCA scenario using a clothed manikin. The primary outcome was time from AED power-on to shock delivery. The secondary outcome was AED pad placement accuracy evaluated using standardized anatomical criteria.

The median time from AED power-on to shock delivery was longer in the scissors group than in the no-scissors group (118 vs 91.5 s; Hodges–Lehmann median difference 24 s, 95% CI 6–39; p = 0.004). The AED pad placement accuracy did not differ between groups (anterior pad: OR 1.00, 95% CI 0.13–7.89; lateral pad: OR 0.67, 95% CI 0.19–2.33). Overall, the correct pad placement rates were low in both groups (10% anterior, 55% lateral).

In this randomized controlled simulation trial, the use of scissors for clothing removal was associated with a longer time from AED power-on to shock delivery, without improvement in pad placement accuracy. These findings do not support routine scissor use under the simulated conditions. Larger studies are needed to determine the role of clothing removal strategies in AED training for lay rescuers.