Abstract
IntroductionCoordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario.MethodsThis was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups.ResultsOut of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47–0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35–1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58–2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08–4.43).ConclusionAssigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits.
Highlights
Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest
Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest
Compressor-Administered Defibrillation on Peri-Shock Pauses manual defibrillation has been associated with a higher frequency of inappropriate shocks and is rapidly falling out of clinical use over defibrillation with pads applied to the chest.[13]
Summary
Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. Using manual over automatic defibrillation eliminates the need for lengthy computer analysis of pre-shock rhythm and minimizes the no-flow fraction.[11,12] Compressor-Administered Defibrillation on Peri-Shock Pauses manual defibrillation has been associated with a higher frequency of inappropriate shocks and is rapidly falling out of clinical use over defibrillation with pads applied to the chest.[13] both the AHA and ERC currently recommend continued chest compressions while the defibrillator is being charged, an action that only recently has been considered to be safe for healthcare providers.[14,15,16]
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