Abstract
AimTo evaluate the effect of pre-charging the defibrillator before rhythm analysis on hands-off time in patients suffering from out-of-hospital cardiac arrest with shockable rhythm. MethodsPre-charging was implemented in the Emergency Medical Service in the Central Denmark Region in June 2018. Training consisted of hands-on simulation scenarios, e-learning material, and written instructions. Data were extracted from the Danish Cardiac Arrest Registry for a 14-month period spanning the implementation of pre-charging. Patients having received at least one shock were included. Transthoracic impedance data were analysed. We recorded hands-off time and peri-shock pauses for all defibrillation procedures and the total hands-off fraction for all cardiac arrests. ResultsImpedance and outcome data were available for 178 patients. 523 defibrillation procedures were analysed. The pre-charge method was associated with shorter median hands-off time per defibrillation procedure (7.6 (IQR 5.8–9.9) vs. 12.6 (IQR 10–16.4) seconds, p < 0.001) but longer pre-shock pause (4 (IQR 2.7–6.1) vs 1.7 (IQR 1.2–3) seconds, p < 0.001) when compared to the current guideline-recommended defibrillation method. The total hands-off fraction per cardiac arrest was reduced after implementation of the pre-charge method (16.5% vs. 20.4%, p = 0.003). No increase in shocks to non-shockable rhythms or personnel was registered. Patients who received only pre-charge defibrillations had an increased odds ratio of return of spontaneous circulation (aOR 2.91; 95%CI 1.09–7.8, p = 0.03). ConclusionPre-charging the defibrillator reduced hands-off time during defibrillation procedures, reduces the total hands-off fraction and may be associated with increased return of spontaneous circulation in out-of-hospital cardiac arrest with shockable rhythm.
Highlights
In Denmark 5000 people per year suffer from out-of-hospital cardiac arrest (OHCA), with a 30-day survival rate of 16%.1 The quality of cardiopulmonary resuscitation (CPR) is important and directly affects the rhythm conversion ratio[2] and survival.Animal and human clinical studies have demonstrated that an increased number and prolonged duration of pauses in chest compressions adversely affect haemodynamics during CPR,[3,4,5,6,7] the shock conversion rate[8] and survival.[9]
Aim: To evaluate the effect of pre-charging the defibrillator before rhythm analysis on hands-off time in patients suering from out-of-hospital cardiac arrest with shockable rhythm
The recommended compression-to-ventilation ratio was changed from 15:2 to 30:2 in 2005.11,12 Resuming chest compressions after rhythm analysis and during defibrillator charging, was recommended by the American Heart Association in 200511 and the European Resuscitation Council (ERC) in 2010.13 To further reduce hands-off time, a possible step could be to charge the defibrillator before pausing chest compressions for rhythm analysis, which potentially enables rhythm analysis and defibrillation to be carried out within a single pause
Summary
Animal and human clinical studies have demonstrated that an increased number and prolonged duration of pauses in chest compressions adversely affect haemodynamics during CPR,[3,4,5,6,7] the shock conversion rate[8] and survival.[9] recent CPR guideline revisions have focused on reducing hands-off time, and the hands-off fraction has decreased in recent years.[10]. The recommended compression-to-ventilation ratio was changed from 15:2 to 30:2 in 2005.11,12 Resuming chest compressions after rhythm analysis and during defibrillator charging, was recommended by the American Heart Association in 200511 and the European Resuscitation Council (ERC) in 2010.13 To further reduce hands-off time, a possible step could be to charge the defibrillator before pausing chest compressions for rhythm analysis, which potentially enables rhythm analysis and defibrillation to be carried out within a single pause. Otto et al recently published a scoping review that identified only three manikin studies and a single human study on defibrillator precharging.[14]
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