Defibrillation is a wildly misunderstood process. Hollywood, as Ken Jennings notes, is way behind the times on this. The paddles? Yelling “clear”? “Jump starting” flat-lining patients like they’re an old jalopy? Please. These days, automated defibrillation using sticky pads is where it’s at, and defibrillation is the last thing flat-lining patients need. So what is being defibrillated like in the real world? What happens to your body when a defibrillator is used on you?
What defibrillators feel like varies depending on which kind is used. The implanted kind, for example, “fire” when you’re conscious, and people say they’re intensely painful. Patients are haunted by the pain they experience with these things, even if they ultimately agree that they’re worth it. The old school paddles, however, are never used on conscious patients and the automated kind “sense” whether or not you need them before they fire. That said, science tells us that the pain of all defibrillation, while unique on a case-by-case basis—all pain is subjective, eh?—is essentially the same (i.e., it sucks). Read on to find out more about what defibrillation really feels like. Clear!
It’s a common misconception that defibrillators—whether it’s the old school “paddles,” modern automated “sticky pads,” or the implanted variety—restart hearts that have stopped beating. Blame Hollywood for this one: a lot of depictions of defibrillators in action show them being used on “flat-lining” patients. In reality, a defibrillator stops a dysfunctional, quivering heartbeat—a so-called “fibrillating” heartbeat— so the heart can (hopefully!) restore its “regular” rhythm on its own (with the help of CPR and possibly adrenaline). So don’t be fooled by what TVTropes calls the “Magical Defibrillator”—shocking a stopped heart won't do any good.
The shock from an automatic implantable cardiac defibrillator (ICD) is notoriously painful. The device is just a bit smaller than a deck of cards but it packs a wallop. ICDs are implantable in people with certain heart conditions - basically, if doctors deem you at risk for ventricular arrhythmias, they might suggest a permanent ICD implant. The University of Michigan’s Frankel Cardiovascular Center advises patients that “people say it feels like being hit in the back with a baseball bat” when it fires. The intense pain, however, “only lasts for a second” and is preferable to, y’know, dying.
The need varies from patient to patient, but manual defibrillators generally work by generating about 300 joules of electrical current, or about “as much as a 100 watt incandescent lamp uses in three seconds.” Only part of that current, however, flows through the heart. Most of it is “dissipated through the resistance of the skin and the rest of the body.”
Ever notice how they always rub the paddles together in the movies? It’s not to build up a charge or anything: that actually comes from the practice of applying conductive gel to the paddles and then rubbing them together for an even application (these days, sticky pads are far more common than paddles anyway). The traditional request for those in the room to "clear" away from the patient ("Clear!") before administering the shock, by the way, still holds true when using hand-held paddles but is considered largely unnecessary when using sticky pads (far less risk of shock).
Cardiologists say that getting hit by manual defibrillation paddles when awake would feel like “being kicked by a mule in the chest.” So it’s a good thing that a so-called “appropriate session” of defibrillation happens when the patient is unconscious. Do patients remember the shock later? Does the pain linger? Nope: experts say “they won’t ever feel or remember the shock.”