Safety and efficacy of defibrillator charging during ongoing chest compressions: A multi-center study

• Published in: Resuscitation Vol. 81; no. 11; pp. 1521 - 1526
• Main Authors: Edelson, Dana P, Robertson-Dick, Brian J, Yuen, Trevor C, Eilevstjønn, Joar, Walsh, Deborah, Bareis, Charles J, Vanden Hoek, Terry L, Abella, Benjamin S
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-11-2010; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Chest compression; Defibrillation; Electric Countershock - instrumentation; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Equipment Safety; Female; Heart arrest; Heart Arrest - physiopathology; Heart Arrest - therapy; Heart Massage; Hospitals, Teaching; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Retrospective Studies; Time Factors; United States; United States; Heart arrest; Chest compression; Defibrillation; Cardiopulmonary resuscitation; Cardiocirculatory arrest; Intensive care; Cardiovascular disease; Resuscitation; Defibrillator
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2010.07.014

Abstract Background Pauses in chest compressions during cardiopulmonary resuscitation have been shown to correlate with poor outcomes. In an attempt to minimize these pauses, the American Heart Association recommends charging the defibrillator during chest compressions. While simulation work suggests decreased pause times using this technique, little is known about its use in clinical practice. Methods We conducted a multi-center, retrospective study of defibrillator charging at three US academic teaching hospitals between April 2006 and April 2009. Data were abstracted from CPR-sensing defibrillator transcripts. Pre-shock pauses and total hands-off time preceding the defibrillation attempts were compared among techniques. Results A total of 680 charge-cycles from 244 cardiac arrests were analyzed. The defibrillator was charged during ongoing chest compressions in 448 (65.9%) instances with wide variability across the three sites. Charging during compressions correlated with a decrease in median pre-shock pause [2.6 s (IQR 1.9–3.8) vs 13.3 s (IQR 8.6–19.5); p < 0.001] and total hands-off time in the 30 s preceding defibrillation [10.3 s (IQR 6.4–13.8) vs 14.8 s (IQR 11.0–19.6); p < 0.001]. The improvement in hands-off time was most pronounced when rescuers charged the defibrillator in anticipation of the pause, prior to any rhythm analysis. There was no difference in inappropriate shocks when charging during chest compressions (20.0% vs 20.1%; p = 0.97) and there was only one instance noted of inadvertent shock administration during compressions, which went unnoticed by the compressor. Conclusions Charging during compressions is underutilized in clinical practice. The technique is associated with decreased hands-off time preceding defibrillation, with minimal risk to patients or rescuers.