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Pause from CPR to defibrillator use critical factor in cardiac arrest survival
Cheskes S. Circulation. 2011;doi:10.1161/circulationaha.110.010736.
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In a recent study, longer pauses in CPR before and after defibrillator use among patients with cardiac arrest in a shockable rhythm resulted in a detrimental effect on survival to hospital discharge.
Researchers of the study pooled data on 815 patients with out-of-hospital cardiac arrest occurring between December 2005 and June 2007. All patients were in the Resuscitation Outcomes Consortium Epistry–Cardiac Arrest and had CPR process data for a minimum of one shock.
After analysis adjusted for survival predictors, researchers found that compared with patients with a pre-shock pause of less than 10 seconds and peri-shock pause of less than 20 seconds, patients with pre-shock pause of at least 20 seconds (OR=0.47; 95% CI, 0.27-0.82) and peri-shock pause of at least 40 seconds (OR=0.54; 95% CI, 0.31-0.97) had a substantially lower likelihood of survival. No association was found between post-shock pause and survival.
Additional analysis revealed that for every 5-second increase in pre-shock pause (for up to 40 seconds), survival to hospital discharge decreased by 18%, whereas for peri-shock pause, survival to hospital discharge decreased by 14% every 5 seconds (up to 50 seconds).
Although recognizing several study limitations, the researchers said the findings have important implications for both defibrillator manufacturers and CPR educators.
Specifically, they wrote: “We suggest multiple methods of decreasing pre-shock pause, including increased use of manual-mode defibrillation for emergency medical service providers, improved algorithms for detecting ventricular fibrillation while working in automatic defibrillator mode, quicker charging of the defibrillator to allow earlier administration of a defibrillatory shock, and performance of CPR during the defibrillator charging phase, all with a goal of attaining an optimal pre-shock pause of 5 seconds. By minimizing the pre-shock pause interval, we may further improve the likelihood of resuscitation success from shockable cardiac arrest.”
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