Perishock Pause

Abstract

BACKGROUND Peri-shock pauses are pauses in chest compressions prior to and following defibrillatory shock. We examined the relationship between peri-shock pauses and survival to hospital discharge. METHODS We included out-of-hospital cardiac arrest (OHCA) patients in the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest who suffered arrest between December 2005 and June 2007, presented with a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) and had CPR process data for at least one shock (n=815). We used multivariable logistic regression to determine the association between survival and peri-shock pauses. RESULTS In an analysis adjusted for Utstein predictors of survival, the odds of survival were significantly lower for patients with pre-shock pause ≥20 seconds (OR: 0.47, 95%CI: 0.27, 0.82) and peri-shock pause ≥40 seconds (OR: 0.54, 95%CI: 0.31, 0.97) when compared to patients with pre-shock pause <10 seconds and peri-shock pause <20 seconds. Post-shock pause was not independently associated with a significant change in the odds of survival. Log linear modeling depicted a decrease in survival to hospital discharge of 18% and 14% for every 5 second increase in both pre- and peri-shock pause interval (up to 40 and 50 seconds respectively) with no significant association noted with changes in the post-shock pause interval. CONCLUSIONS In patients with cardiac arrest presenting in a shockable rhythm longer peri-shock and pre-shock pauses were independently associated with a decrease in survival to hospital discharge. The impact of pre-shock pause on survival suggests refinement of automatic defibrillator software and paramedic education to minimize pre-shock pause delays may have significant impact on survival.

An evaluation of three methods of in-hospital cardiac arrest educational debriefing: The cardiopulmonary resuscitation debriefing study

“…There was a general improvement in CPR quality by cardiac arrest teams across all hospital sites. Some statistically significant improvements were observed, but the effect size of these improvements were small and their influence on clinical outcomes uncertain.. [21,24,25] The study found no evidence that interventions were associated with an effect on patient outcome, but the study was not powered to detect such differences.…”

Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS‐KANTO [Survey of Survivors after Out‐of‐Hospital Cardiac Arrest in Kanto Area] 2012 Study)

“…In addition, in human case reports, it was observed that switching from mCPR to manual compressions enabled increasing chest compression depth, resulting in hemodynamic improvement, which highlighted the usefulness of physiological monitoring during CPR 50. There is clinical evidence to support that the assessment of CPR quality has revealed significant increases in survival and a favorable neurological function after cardiac arrest 51, 52. Thus, it is possible that the use of mCPR with an assessment of CPR quality may be useful to improve the resuscitation performance.…”

The impact of prehospital resuscitation research on in-hospital care

“…With every 5-second increase in pre-and peri-shock pause, the probability of survival was reduced by 18% and 14%, respectively. 18,19 These components of CPR quality are not only highlighted as benchmarks for prehospital resuscitation, but also are increasingly becoming standards to which in-hospital resuscitation should strive. In an attempt to improve adherence to evidence-based care of patients who sustain cardiac arrest, the AHA developed a quality improvement program known as Get with the Guidelines-Resuscitation.…”