Abstract P65: Novel Technology to Limit Chest Compression Interruption With Experienced Advanced Life Support Providers
Introduction: Chest compression (CC) interruptions are detrimental during the resuscitation of cardiac arrest patients especially immediately prior to shock delivery. As a result of CC-induced artifact, advanced life support (ALS) providers must pause CC to determine whether to charge the defibrillator. New defibrillator technology is available to reduce CC-induced artifact and provide reliable rhythm analysis with automatic defibrillator charging to eliminate pre-shock CC interruption. We hypothesized that CC interruption would be reduced when ALS providers operated the defibrillator in this new mode compared with the standard manual mode of operation.
Methods: Ten paramedics participated in a randomized crossover mannequin study. Subjects performed one trial with an E-series defibrillator (ZOLL Medical) in manual mode and another in the new CPR Ready Charge (CRC) mode. Participants rested a minimum of 30 minutes between trials and watched a 5 minute training video before using the CRC mode. Subjects worked in pairs to perform 8 intervals of CC. A simulated waveform was displayed in each interval and the order of waveforms (4 shockable and 4 non-shockable) was randomly assigned. For each interval, subjects performed 2 minutes of continuous CC, analyzed the patient’s rhythm and delivered a shock if appropriate. In the CRC mode, analysis and charging occurred automatically during CC. Every 2 intervals, subjects switched roles as chest compressor and defibrillator operator. Paired t-tests were used to compare CC interruptions in the CRC and manual mode trials.
Results: CC interruption was significantly reduced with CRC (43.2±7.3 sec CRC vs. 104.2±30.6 sec manual, p=0.005). No-flow fraction was reduced from 9.38% with manual operation to 4.38% with CRC. In particular, the pause prior to shock delivery was decreased with CRC (3.0±1.2 sec CRC vs.10.2±1.9 sec manual, p<0.0001). Because CRC eliminates pauses for analysis, the total time required to complete 8 intervals of CC was shorter in the CRC compared with manual trial (16.4±0.1 min CRC vs. 18.4±0.4 min manual, p=0.0003)
Conclusions: No-flow fraction was reduced by approximately 50% and pre-shock pause was reduced by 70% utilizing a novel technology employing automated analysis and charging during CC.