Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest

Abstract

Background-Prior investigation of out-of-hospital cardiac arrest has raised the concern that ventricular fibrillation (VF) recurrence may be triggered by chest compression (CC) resumption. We investigated predictors of VF recurrence after defibrillation, including timing of CC resumption. Methods and Results-Patients with witnessed out-of-hospital cardiac arrest and initial rhythm of VF from an Utstein-style database were analyzed. For each shock that defibrillated VF, CC resumption and VF recurrence times were determined. Shocks were classified according to postshock rhythm. Factors (age, sex, time from dispatch to monitor/defibrillator application, and CC resumption) that could predict VF recurrence were analyzed. CC resumption was categorized into groups: CC1, 1 to 5 seconds; CC2, 6 to 10 seconds; CC3, 11 to 30 seconds; and CC4, >30 seconds. Eighty-eight subjects were analyzed, with a total of 285 shocks, with 226 shocks that achieved asystole (n=102), organized rhythm (n=120), or monomorphic ventricular tachycardia (n=4). After a successful shock, CC resumption occurred at a median (interquartile range) of 8 (5-18)

Part 7: Adult Advanced Cardiovascular Life Support

“…97 Another study of patients presenting in VF after a witnessed arrest concluded that recurrence of VF within 30 seconds of a shock was not affected by the timing of resumption of chest compressions. 98 Thus, the effect of chest compressions on recurrent VF is not clear. It is likely that in the future, algorithms that recognize recurrent VF during chest compressions with high sensitivity and specificity will allow us to deliver a shock earlier in the CPR cycle, thereby reducing the length of time the myocardium is fibrillating and the duration of postshock CPR.…”

European Resuscitation Council Guidelines for Resuscitation 2015

“…334 If a shock has been successful immediate resumption of chest compressions does not increase the risk of VF recurrence. 335 Furthermore, the delay in trying to palpate a pulse will further compromise the myocardium if a perfusing rhythm has not been restored. 336 • Continue CPR for 2 min, then pause briefly to assess the rhythm; if still VF/pVT, give a second shock (150-360 J biphasic).…”

Minimizing pre- and post-shock pauses during the use of an automatic external defibrillator by two different voice prompt protocols. A randomized controlled trial of a bundle of measures

“…Chest compression rates did not significantly differ between the two groups. The time from connection of the AED to first shock was significantly shorter in the control group than the experimental group (experimental: 34 [31-38] s vs. control: 21 [19][20][21][22][23][24] s; P < 0.001), due to the introduction of 15 s of CPR before in shock in the experimental protocol. The per-protocol analysis showed comparable results for the secondary outcomes (Supplemental Table 3).…”