Part 6: Defibrillation

Sunde, Kjetil; Deakin, Charles D.; Hazinski, Mary Fran; Morrison, Laurie J.; Nolan, Jerry P.; Sayre, Michael R.; Angelos, Mark G.; Baubin, Michael; Bellolio, M.F.; Berlin, Paul; Bradley, Richard N; Bradley, Steven M; Drajer, Saúl; Eftestøl, Trygve; Genka, Chokoh; Hess, Erik P.; Jacobs, Ian; Kerber, Richard E.; Koster, Rudolph W.; Mayumi, Toshihiko; Nazarian, Saman; Nolan, Jerry P.; Peele, Mark E.; Ranniger, Claudia; Ristagno, Giuseppe; Sasson, Comilla; Sun, Shijie

doi:10.1161/circulationaha.110.971010

Cited by 74 publications

(43 citation statements)

References 181 publications

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“…For each shock, we determined VF termination outcome, defined as the absence of VF for at least 5 seconds after the shock. 14,18,19 For analysis of the probability of VF termination, we excluded shocks for which the preshock no-compression interval could not be measured in full.…”

Section: Discussionmentioning

confidence: 99%

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Brouwer

Walker²,

Chapman³

et al. 2015

Circulation

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Background-Minimizing pauses in chest compressions during cardiopulmonary resuscitation is a focus of current guidelines. Prior analyses found that prolonged pauses for defibrillation (perishock pauses) are associated with worse survival. We analyzed resuscitations to characterize the association between pauses for all reasons and both ventricular fibrillation termination and patient survival. Methods and Results-In 319 patients with ventricular tachycardia/fibrillation out-of-hospital cardiac arrest, we analyzed recordings from all defibrillators used during resuscitation and measured durations of all cardiopulmonary resuscitation pauses. Median durations were 32 seconds (25th and 75th percentile, 22 and 52 seconds) for the longest pause for any reason, 23 seconds (25th and 75th percentile, 14 and 34 seconds) for the longest perishock pause, and 24 seconds (25th and 75th percentile, 11 and 38 seconds) for the longest nonshock pause. Multivariable regression models showed lower odds for survival per 5-second increase in the longest overall pause (odds ratio, 0.89; 95% confidence interval, 0.83-0.95), longest perishock pause (odds ratio, 0.85; 95% confidence interval, 0.77-0.93), and longest nonshock pause (odds ratio, 0.83; 95% confidence interval, 0.75-0.91). In 36% of cases, the longest pause was a nonshock pause; this subgroup had lower survival than the group in whom the longest pause was a perishock pause (27% versus 44%, respectively; P<0.01) despite a higher chest compression fraction. Preshock pauses were 8 seconds (25th and 75th percentile, 4 and 17 seconds) for shocks that terminated ventricular fibrillation and 7 seconds (25th and 75th percentile, 4 and 13 seconds) for shocks that did not (P=0.18). Conclusions-Prolonged pauses have a negative association with survival not explained by chest compression fraction or decreased ventricular fibrillation termination rate. Ventricular fibrillation termination was not the mechanism linking pause duration and survival. Strategies shortening the longest pauses may improve outcome.

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Section: Discussionmentioning

confidence: 99%

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Brouwer

Walker²,

Chapman³

et al. 2015

Circulation

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“…13 The first question concerned whether CPR should be provided before defibrillation is attempted. The second question concerned the number of shocks to be delivered in a sequence before the rescuer resumes CPR.…”

Section: New Recommendations To Integrate Cpr and Aed Usementioning

confidence: 99%

Part 6: Electrical Therapies

Link¹,

Atkins²,

Passman³

et al. 2010

Circulation

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267

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“…13 Evidence suggests that minimizing pauses in CPR improves the chance of recovery from shock. While our patient awaited more definitive treatment, chest compressions were executed sufficiently to maintain his mean arterial pressure above 60 mmHg.…”

Section: Discussionmentioning

confidence: 99%

A Case of Survival after Cardiac Arrest and 3½ Hours of Resuscitation

Nusbaum¹,

Bassett²,

Gregorič³

et al. 2014

Texas Heart Institute Journal

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I n general, outcomes after cardiac arrest remain poor, especially in patients with risk factors such as unwitnessed arrest, unfavorable initial rhythm, older age, and prolonged resuscitation without return of spontaneous circulation (ROSC). 1-4Guidelines therefore exist for terminating resuscitative efforts in cases of cardiac arrest that are deemed futile. 5,6 Nonetheless, successful resuscitation and good recovery after prolonged arrest have been documented. [7][8][9][10] As the field of cardiopulmonary resuscitative medicine evolves, new techniques are being implemented to improve outcomes in patients who are in cardiac arrest. We present an example of how recent research findings in resuscitative medicine improved one patient's chances of survival. Case ReportIn June 2011, a 40-year-old white man with a history of hypertension, hyperlipidemia, obesity (body mass index, 34.9 kg/m 2 ), and chronic tobacco use presented with presyncopal symptoms. Severe pressure-like chest pain had started 24 hours previously and had completely resolved spontaneously 12 hours before the current presentation. An electrocardiogram (ECG) showed persistent ST-segment elevation in the anterior leads. He was hemodynamically well compensated. Initial laboratory reports showed cardiac troponin I elevation to a level above 50 ng/mL.The patient was not a candidate for primary percutaneous coronary intervention (PCI) for STEMI because of his delayed presentation, the complete resolution of his chest pain, and the development of anterior Q waves on his ECG. He was admitted to the cardiovascular care unit (CCU) and was treated conservatively with antiplatelet, anticoagulant, and antiarrhythmic therapy.The next morning, a coronary angiogram revealed an occluded proximal left anterior descending coronary artery, an occluded obtuse marginal branch, and a diffusely diseased right coronary artery. On hospital day 3, a positron emission tomographic viability scan showed only minimal viable myocardium and a large area of scar tissue; therefore, the patient was not a candidate for revascularization. He remained hemodynamically stable in the CCU and was subsequently transferred to the medicine floor.At 5:37 am on hospital day 5, the patient experienced sustained ventricular tachycardia and then lost consciousness. He had no spontaneous respirations, and neither the carotid nor femoral pulses could be palpated. His airway was secured, and positive-pressure ventilation was initiated. Simultaneously, cardiopulmonary resuscita-

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Part 6: Defibrillation

Cited by 74 publications

References 181 publications

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest

Part 6: Electrical Therapies

A Case of Survival after Cardiac Arrest and 3½ Hours of Resuscitation

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