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

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.