Abstract 247: Hands-on Defibrillation Has the Potential to Improve CPR Quality and Is Safe for Rescuers: A Preclinical Study

Abstract

Background: It has been demonstrated that hands-on chest compressions (CC) during cardioversion in humans can be safely performed. [1] We assessed the hypothesis that it will be safe during CPR and improves its quality. Methods: Twenty anesthetized swine were subjected to V-fib and subsequent CPR. Self-adhesive defibrillation electrodes were used with a biphasic defibrillator (corpuls3, G. Stemple GmbH, Germany). Swine were randomized either to i) hands-on defibrillation, where rescuers wore polyethylene gloves and defibrillation was delivered during ongoing CC, or ii) conventional hands-off defibrillation. In the hands-on group CC were interrupted only for rhythm analysis, when a marked increase of arterial blood pressure or endtidal CO 2 was observed suggesting spontaneus circulation. Holter ECG was registered to analyze potential cardiac arrhythmias in rescuers. Results: ROSC was achieved in 9 out of 10 swine in the hands-on group compared to 8 out of 10 (ns). Interruptions in CC were reduced by hands-on technique (p < 0.001) and coronary perfusion pressure (CorPP) was earlier restored to the pre-shock level (p = 0.014). In only 13 of 34 cases (38 %) interruption of hands-on CPR revealed a stable spontaneous circulation. Transthoracic impedance was not significantly different (hands-on 66 ± 40 Ohm vs. hands-off 63 ± 24 Ohm, p = 0.720). During all 37 hands-on shocks rescuers never felt any kind of electric stimulus. Holter ECG analysis did not reveal any serious arrhythmia during hands-on CPR (SVES/h: 5.0 ± 5.4, PVC/h: 0.2 ± 0.5). Conclusions: Hands-on defibrillation shortens CPR pauses and fastens restoration of CorPP that is predictive for CPR outcome. More sophisticated ECG filters may enable rhythm analysis during ongoing CC to avoid unnecessary pauses. Hands-on CPR can be safely performed but clinical studies are needed before implementation into daily practice.