Abstract 17: Ambulance Paramedics Interrupt Chest Compressions And Delay Defibrillation After Taking Over From Lay Rescuers With An Automated External Defibrillator

Abstract

Introduction: There are no guidelines for transition of care from rescuers with AED to paramedics with ongoing CPR. After disconnection of the AED, clock time as running in the AED is not available for subsequent protocollized CPR duration, rhythm check and shock. We hypothesize that defibrillation shocks are delayed and CPR interrupted without reason after AED disconnection. Methods: This was a prospective observational community study in an area of 2.6 million inhabitants. During 16 months, all available continuous ECG recordings of AEDs and associated manual defibrillator (mDFB) recordings of out-of-hospital cardiac arrests were collected. All clock times were synchronized. We observed CPR time through the impedance signal. For shockable rhythms, we measured the duration of CPR given between the connection time of the mDFB and expected time of defibrillation of the AED. For non shockable rhythms, the expected moment of AED rhythm analysis was the endpoint of the time interval. Time available for CPR given during that time interval was set at 100%. Delay in defibrillation was the difference between expected moment of the next shock as advised by the AED and the actual shock given by paramedics. Results: Results are shown in table 1 . Of the 245 cases, 73 cases had a shockable rhythm during take over, 141 a non-shockable rhythm and 31 patients had Return of Spontaneous Circulation. A shock was delivered too early or too late in 68 of 73 patients. Four patients were never defibrillated. Conclusion: Disconnection of the AED by professionals interrupts the treatment protocol of the AED, delaying time of defibrillation by almost two minutes. Premature defibrillation leads to decrease in CPR time. The optimal moment of disconnecting the AED should be described in new guidelines. Table 1: Shock delay and CPR interruption, devided in shockable and non shockable rhythms