Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study

Abstract

IntroductionEarly defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation.MethodsFinal-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario.ResultsThe median time needed for defibrillation was 158 s (n = 49, interquartile range: 107–270 s), more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49) was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17%) of the overall time needed for defibrillation (maximum 67%). Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused.ConclusionsOur study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of defibrillation delay and can be used to generate new hypotheses on how to provide a timely defibrillation.

Characteristics and outcomes of out-of-hospital cardiac arrest patients before and during the COVID-19 pandemic in Thailand

“…The Pan Asia Resuscitation Outcomes Study (PAROS), a study of OHCA characteristics in Asian countries, reported that the survival-todischarge rate varied from 0.5 to 8.5%, and survival with good neurological function ranged from 1.6% to 3% (11). These outcomes are notably low in comparison to results reported in studies in European countries and the United States (3); this is presumably secondary to ineffective or delayed chest compression either from bystander witnesses or prehospital medical teams because the rate of successful ROSC decreases by 7%-10% for every minute waited (12). Therefore, to minimize mortality and convey patients with preferable neurological outcomes, emergency medical service (EMS) performance of cardiopulmonary resuscitation (CPR) is considered the key element to delivering high-quality procedures in the shortest response time (13,14).…”

Conhecimento de estudantes da saúde sobre suporte básico de vida

“…Já a última seção foi subdividida em 4 perguntas referentes à ventilação, 3 referentes à compressão torácica e 4 referentes ao uso de um Desfibrilador Externo Automático (DEA). A avaliação e manejo da via aérea é de extrema dificuldade para pessoas não treinadas e é um fator de atraso à desfibrilação precoce 15 .…”

The Cardiopulmonary Resuscitation Success Rate and Its Related Factors in Patients Referred to Dr. Heshmat Hospital in Rasht, Iran

“…ardiovascular diseases are one of the most important leading causes of death worldwide such that, in Iran, 43% of all deaths are due to cardiovascular diseases [1] and is often associated with ischemic heart disease [2]. Annually, there are approximately 375.000-700.000 cases of cardiac arrest in Europe [3].…”