Defibrillator charging before rhythm analysis causes peri-shock pauses exceeding guideline recommended maximum 5 s

Kemper, M.; Zech, Alexandra; Lazarovici, M; Zwißler, Bernhard; Prückner, S.; Meyer, Oliver

doi:10.1007/s00101-019-0623-x

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…The results of the 3 manikin studies showed reduced overall pause duration during the compression cycle, but increased pre, post, and perishock pause duration with anticipatory charging. 22 , 23 , 24 …”

Section: Defibrillation Strategies For Ventricular Fibrillation or Pumentioning

confidence: 99%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

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Section: Defibrillation Strategies For Ventricular Fibrillation or Pumentioning

confidence: 99%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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“…21,22 However, one manikin study found that the duration of peri-shock pauses increased. 23 Thus, clinical data are scarce and the impacts of precharging on hands-off time and durations of pre-and post-shock pauses in OHCA are uncertain.…”

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confidence: 99%

Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm

et al. 2021

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Aim: To Q3 evaluate the eect of pre-charging the defibrillator before rhythm analysis on hands-o time in patients suering from out-of-hospital cardiac arrest with shockable rhythm.Methods: Pre-charging was implemented in the Emergency Medical Service in the Central Denmark Region in June 2018. Training consisted of hands-on simulation scenarios, e-learning material, and written instructions. Data were extracted from the Danish Cardiac Arrest Registry for a 14month period spanning the implementation of pre-charging. Patients having received at least one shock were included. Transthoracic impedance data were analysed. We recorded hands-o time and peri-shock pauses for all defibrillation procedures and the total hands-o fraction for all cardiac arrests.Results: Impedance and outcome data were available for 178 patients. 523 defibrillation procedures were analysed. The pre-charge method was associated with shorter median hands-o time per defibrillation procedure (7.6 (IQR 5.8-9.9) vs. 12.6 (IQR 10-16.4) seconds, p < 0.001) but longer pre-shock pause (4 (IQR 2.7-6.1) vs 1.7 (IQR 1.2-3) seconds, p < 0.001) when compared to the currently guideline-recommended defibrillation method. The total hands-o fraction per cardiac arrest was reduced after implementation of the pre-charge method (16.5% vs. 20.4%, p = 0.003).No increase in shocks to non-shockable rhythms or personnel was registered. Patients who received only pre-charge defibrillations had an increased odds ratio of return of spontaneous circulation (aOR 2.91; 95%CI 1.09-7.8, p = 0.03). Conclusion:Pre-charging the defibrillator reduced hands-o time during defibrillation procedures, reduces the total hands-o fraction and may be associated with increased return of spontaneous circulation in out-of-hospital cardiac arrest with shockable rhythm.

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“…Thus, an ‘anticipatory defibrillator charging’ strategy has been recently proposed, in which the defibrillator is charged at the end of a 2-min cycle of chest compressions, before rhythm analysis. Unexpectedly, this approach was associated with an excessively long peri-shock pause during CPR, limiting its clinical use [20 ▪▪ ,24].…”

Section: Ecg Analysis During Ongoing Chest Compressionsmentioning

confidence: 99%

Optimizing defibrillation during cardiac arrest

Babini

Ruggeri

Ristagno

2021

Current Opinion in Critical Care

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Purpose of reviewCurrent cardiac arrest guidelines are based on a fixed, time-based defibrillation strategy. Rhythm analysis and shock delivery (if indicated) are repeated every 2 min requiring cyclical interruptions of chest compressions. This approach has several downsides, such as the need to temporarily stop cardiopulmonary resuscitation (CPR) for a variable amount of time, thus reducing myocardial perfusion and decreasing the chance of successful defibrillation. A tailored defibrillation strategy should identify treatment priority for each patient, that is chest compressions (CCS) or defibrillation, minimize CCs interruptions, speed up the delivery of early effective defibrillation and reduce the number of ineffective shocks. Recent findingsReal-time ECG analysis (using adaptive filters, new algorithms robust to chest compressions artifacts and shock-advisory algorithms) is an effective strategy to correctly identify heart rhythm during CPR and reduce the hands-off time preceding a shock. Similarly, ventricular fibrillation waveform analysis, that is amplitude spectrum area (AMSA) represents a well established approach to reserve defibrillation in patients with high chance of shock success and postpone it when ventricular fibrillation termination is unlikely. Both approaches demonstrated valuable results in improving cardiac arrest outcomes in experimental and observational study.

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Defibrillator charging before rhythm analysis causes peri-shock pauses exceeding guideline recommended maximum 5 s

Cited by 6 publications

References 29 publications

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm

Optimizing defibrillation during cardiac arrest

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