Remove Medication Patches Before AED Application
Yes, remove all transdermal medication patches from the chest before applying AED pads to prevent burns, arcing, and ensure effective defibrillation.
Primary Recommendation
The most recent 2025 AHA Guidelines 1 emphasize that AED pads require "direct contact with the skin" and must be "applied directly to the bare chest" for optimal energy delivery to the myocardium. While the guideline doesn't explicitly address patches in the main text, this requirement for direct skin contact necessitates patch removal.
Why Patches Must Be Removed
Safety Concerns - Risk of Burns and Arcing
Historical case reports document serious complications when defibrillating through patches:
- Nitroglycerin patches: A 1990 case reported a small explosion during defibrillation when a paddle was placed over a nitroglycerin patch, with arcing from the aluminum backing being the likely cause 2
- Analgesic patches: A 2009 case documented dermal burns following ICD shock delivery when a transdermal patch was positioned over the device 3
- Metal-containing patches: Many transdermal patches contain metallic components (aluminum backing, metal foil) that conduct electricity and create burn risk [4, @12@]
Impedance and Energy Delivery
Patches create a barrier between the AED pad and skin, increasing transthoracic impedance and reducing effective energy delivery to the heart. The 2025 guidelines stress that "adequate contact be made at the pad-skin interface so as to optimize energy delivery" 5.
Clinical Implementation
Before applying AED pads:
- Quickly scan the chest for any patches (they appear as square or rectangular adhesive patches, often tan or clear)
- Remove all patches immediately - grasp edge and pull off in one motion
- Wipe the area briefly if residual medication or adhesive remains
- Apply AED pads directly to bare, dry skin
Do not delay defibrillation - patch removal should take only seconds. If a patch is directly under where a pad needs to go, remove it; if it's peripheral to the pad placement site, you may proceed if removal would cause significant delay.
Common Patch Locations to Check
- Upper chest (nitroglycerin, clonidine)
- Upper back/shoulder area (fentanyl, lidocaine)
- Lateral chest wall (hormone patches, scopolamine)
Critical Caveat
The 2025 guidelines note that females receive significantly lower rates of public access defibrillation, partly due to hesitation about exposing the chest 1. Do not let concerns about removing patches delay defibrillation - every second counts in cardiac arrest. Remove patches quickly as part of exposing the chest, but prioritize speed of shock delivery above all else.