Abstract 4: Long Pauses in Chest Compression are Common During Advanced Cardiac Life Support Cardiopulmonary Resuscitation
Introduction: To optimize circulation during cardiopulmonary resuscitation (CPR), interruptions in chest compressions should be minimized. The incidence and length of individual pauses in chest compression (PCCs) during out-of-hospital CPR efforts have not been quantified.
Hypothesis: We assessed the hypothesis that long pauses (> 10 seconds) are common during CPR in out-of-hospital resuscitations.
Methods: Following intubation, electrocardiograph (ECG) and invasive femoral arterial blood pressure (BP) were recorded prospectively during advanced life support (ALS) CPR in a convenience sample of adult (> 21 years old) cardiac arrest victims in an urban EMS system as part of an impedance threshold device study. Recordings were retrospectively reviewed to identify frequency and duration of PCCs, defined as a continuous, absent arterial BP waveform during resuscitation.
Results: Patients (n=22) with simultaneous ECG and BP recordings during CPR were studied. The average (±SEM) age was 61 ± 20 years; 13 (59%) were male. Initial arrest rhythms were ventricular fibrillation (n=3 [14%]), PEA (n=7 [32%]) and asystole (n=12 [54%]). A total of 3.5 hours of CPR time was continuously recorded: 284 PCCs represented 32.7% of this time. Of these, 158 PCCs were 1–2 seconds in length, consistent with incorrectly performed synchronous ventilation after intubation. Eighty-four PCCs were > 10 sec in length with a mean duration of 44.2 ± 4.2 sec/PCC. Pauses > 10 sec accounted for 87.7% of total PCC time.
Conclusions: Lengthy interruptions in chest compressions are a common error during out-of-hospital ALS CPR. PCCs were observed in all cases, accounting for >20 sec/min of no CPR. Rescuers and CPR training programs should focus on minimizing the duration and frequency of non-chest compression activities. Only asynchronous ventilation should be performed following intubation. Methods to limit frequency and duration of PCCs during delivery of CPR should be encouraged, including monitoring quality of CPR.