Published online before print June 24, 2002, doi: 10.1161/01.CIR.0000021429.22005.2E
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2002;106:368.)
© 2002 American Heart Association, Inc.
Basic Science Reports |
Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation
From The Institute of Critical Care Medicine, Palm Springs (T.Y., M.H.W., W.T., S.S., K.K., H.P., J.B.), and the Keck School of Medicine of the University of Southern California, Los Angeles (M.H.W., W.T., S.S., J.B.), Calif.
Correspondence to Max Harry Weil, MD, PhD, The Institute of Critical Care Medicine, 1695 N Sunrise Way, Building 3, Palm Springs, CA 92262-5309. E-mail weilm{at}911research.org
Background— Current versions of automated external defibrillators (AEDs) require frequent stopping of chest compression for rhythm analyses and capacity charging. The present study was undertaken to evaluate the effects of these interruptions during the operation of AEDs.
Methods and Results— Ventricular fibrillation was electrically induced in 20 male domestic swine weighing between 37.5 and 43 kg that were untreated for 7 minutes before CPR was started. Defibrillation was attempted with up to 3 sequential 150-J biphasic shocks, but each was preceded by 3-, 10-, 15-, or 20-second interruptions of chest compression. The interruptions corresponded to those that were mandated by commercially marketed AEDs for rhythm analyses and capacitor charge. The sequence of up to 3 electrical shocks and delays were repeated at 1-minute intervals until the animals were successfully resuscitated or for a total of 15 minutes. Spontaneous circulation was restored in each of 5 animals in which precordial compression was delayed for 3 seconds before the delivery of the first and subsequent shocks but in none of the animals in which the delay was >15 seconds before the delivery of the first and subsequent shocks. Longer intervals of CPR interventions were required, and there was correspondingly greater failure of resuscitation in close relationship to increasing delays. The durations of interruptions were inversely related to the durations of subthreshold levels of coronary perfusion pressure. Postresuscitation arterial pressure and left ventricular ejection fraction were more severely impaired with increasing delays.
Conclusions— Interruptions of precordial compression for rhythm analyses that exceed 15 seconds before each shock compromise the outcome of CPR and increase the severity of postresuscitation myocardial dysfunction.
Key Words: cardiopulmonary resuscitation • fibrillation • defibrillation • compression • myocardium
This article has been cited by other articles:
 |
|
 |
|
  J. Christenson, D. Andrusiek, S. Everson-Stewart, P. Kudenchuk, D. Hostler, J. Powell, C. W. Callaway, D. Bishop, C. Vaillancourt, D. Davis, et al. Chest Compression Fraction Determines Survival in Patients With Out-of-Hospital Ventricular Fibrillation Circulation, September 29, 2009; 120(13): 1241 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Sutton, D. Niles, J. Nysaether, B. S. Abella, K. B. Arbogast, A. Nishisaki, M. R. Maltese, A. Donoghue, R. Bishnoi, M. A. Helfaer, et al. Quantitative Analysis of CPR Quality During In-Hospital Resuscitation of Older Children and Adolescents Pediatrics, August 1, 2009; 124(2): 494 - 499. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Kajino, T Iwami, R A Berg, A Hiraide, Y Hayashi, H Yukioka, H Tanaka, T Shimazu, and H Sugimoto Comparison of neurological outcomes following witnessed out-of-hospital ventricular fibrillation defibrillated with either biphasic or monophasic automated external defibrillators Emerg. Med. J., July 1, 2009; 26(7): 492 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Ewy Do Modifications of the American Heart Association Guidelines Improve Survival of Patients with Out-of-Hospital Cardiac Arrest? Circulation, May 19, 2009; 119(19): 2542 - 2544. [Full Text] [PDF]
|
|
|
|
|
|
A. G. Garza, M. C. Gratton, J. A. Salomone, D. Lindholm, J. McElroy, and R. Archer Improved Patient Survival Using a Modified Resuscitation Protocol for Out-of-Hospital Cardiac Arrest Circulation, May 19, 2009; 119(19): 2597 - 2605. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Lloyd, B. Heeke, P. F. Walter, and J. J. Langberg Hands-On Defibrillation: An Analysis of Electrical Current Flow Through Rescuers in Direct Contact With Patients During Biphasic External Defibrillation Circulation, May 13, 2008; 117(19): 2510 - 2514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Woollard and K. Mackway-Jones All that glistens is not gold Emerg. Med. J., May 1, 2008; 25(5): 251 - 252. [Full Text] [PDF]
|
|
|
|
 |
|
 W. H Ibrahim Recent advances and controversies in adult cardiopulmonary resuscitation Postgrad. Med. J., October 1, 2007; 83(984): 649 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ali and A. M. Zafari Narrative Review: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Review of the Current Guidelines Ann Intern Med, August 7, 2007; 147(3): 171 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Ristagno, W. Tang, Y.-T. Chang, D. B. Jorgenson, J. K. Russell, L. Huang, T. Wang, S. Sun, and M. H. Weil The Quality of Chest Compressions During Cardiopulmonary Resuscitation Overrides Importance of Timing of Defibrillation Chest, July 1, 2007; 132(1): 70 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Losert, F. Sterz, K. Kohler, G. Sodeck, R. Fleischhackl, P. Eisenburger, A. Kliegel, H. Herkner, H. Myklebust, J. Nysaether, et al. Quality of Cardiopulmonary Resuscitation Among Highly Trained Staff in an Emergency Department Setting Arch Intern Med, November 27, 2006; 166(21): 2375 - 2380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Kudenchuk, L. A. Cobb, M. K. Copass, M. Olsufka, C. Maynard, and G. Nichol Transthoracic Incremental Monophasic Versus Biphasic Defibrillation by Emergency Responders (TIMBER): A Randomized Comparison of Monophasic With Biphasic Waveform Ascending Energy Defibrillation for the Resuscitation of Out-of-Hospital Cardiac Arrest due to Ventricular Fibrillation Circulation, November 7, 2006; 114(19): 2010 - 2018. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Hallstrom, T. D. Rea, M. R. Sayre, J. Christenson, A. R. Anton, V. N. Mosesso Jr, L. Van Ottingham, M. Olsufka, S. Pennington, L. J. White, et al. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. JAMA, June 14, 2006; 295(22): 2620 - 2628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Tang, D. Snyder, J. Wang, L. Huang, Y.-T. Chang, S. Sun, and M. H. Weil One-Shock Versus Three-Shock Defibrillation Protocol Significantly Improves Outcome in a Porcine Model of Prolonged Ventricular Fibrillation Cardiac Arrest Circulation, June 13, 2006; 113(23): 2683 - 2689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Heart Association 2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Basic Life Support Pediatrics, May 1, 2006; 117(5): e989 - e1004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 3: Overview of CPR Circulation, December 13, 2005; 112(24_suppl): IV-12 - IV-18. [Full Text] [PDF]
|
|
|
|
|
|
Part 4: Adult Basic Life Support Circulation, December 13, 2005; 112(24_suppl): IV-19 - IV-34. [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Electrical Therapies: Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing Circulation, December 13, 2005; 112(24_suppl): IV-35 - IV-46. [Full Text] [PDF]
|
|
|
|
|
|
Part 7.2: Management of Cardiac Arrest Circulation, December 13, 2005; 112(24_suppl): IV-58 - IV-66. [Full Text] [PDF]
|
|
|
|
|
|
Part 11: Pediatric Basic Life Support Circulation, December 13, 2005; 112(24_suppl): IV-156 - IV-166. [Full Text] [PDF]
|
|
|
|
|
|
M. F. Hazinski, V. M. Nadkarni, R. W. Hickey, R. O'Connor, L. B. Becker, and A. Zaritsky Major Changes in the 2005 AHA Guidelines for CPR and ECC: Reaching the Tipping Point for Change Circulation, December 13, 2005; 112(24_suppl): IV-206 - IV-211. [Full Text] [PDF]
|
|
|
|
|
|
Part 2: Adult Basic Life Support Circulation, November 29, 2005; 112(22_suppl): III-5 - III-16. [Full Text] [PDF]
|
|
|
|
|
|
Part 6: Pediatric Basic and Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-73 - III-90. [Full Text] [PDF]
|
|
|
|
|
|
A. A. El-Menyar The Resuscitation Outcome: Revisit the Story of the Stony Heart Chest, October 1, 2005; 128(4): 2835 - 2846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Valenzuela, K. B. Kern, L. L. Clark, R. A. Berg, M. D. Berg, D. D. Berg, R. W. Hilwig, C. W. Otto, D. Newburn, and G. A. Ewy Interruptions of Chest Compressions During Emergency Medical Systems Resuscitation Circulation, August 30, 2005; 112(9): 1259 - 1265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. Ewy Cardiocerebral Resuscitation: The New Cardiopulmonary Resuscitation Circulation, April 26, 2005; 111(16): 2134 - 2142. [Full Text] [PDF]
|
|
|
|
|
|
L. Wik, J. Kramer-Johansen, H. Myklebust, H. Sorebo, L. Svensson, B. Fellows, and P. A. Steen Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac Arrest JAMA, January 19, 2005; 293(3): 299 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Abella, J. P. Alvarado, H. Myklebust, D. P. Edelson, A. Barry, N. O'Hearn, T. L. Vanden Hoek, and L. B. Becker Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest JAMA, January 19, 2005; 293(3): 305 - 310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. B. Sanders and G. A. Ewy Cardiopulmonary Resuscitation in the Real World: When Will the Guidelines Get the Message? JAMA, January 19, 2005; 293(3): 363 - 365. [Full Text] [PDF]
|
|
|
|
|
|
M. H. Weil, W. Tang, and J. Bisera Cardiopulmonary Resuscitation: One Size Does Not Fit All Circulation, February 18, 2003; 107(6): 794 - 794. [Full Text] [PDF]
|
|
|
|
|
|
M. L. Weisfeldt and L. B. Becker Resuscitation After Cardiac Arrest: A 3-Phase Time-Sensitive Model JAMA, December 18, 2002; 288(23): 3035 - 3038. [Full Text] [PDF]
|
|