Abstract 2644: Defibrillator Charging During On-Going Chest Compressions: A Multi-Center Study of In-Hospital Resuscitation
BACKGROUND: Pauses in chest compressions, specifically in the time preceding defibrillation, have been shown to be detrimental. The Advanced Cardiac Life Support guidelines were amended in 2005 to recommend defibrillator charging during on-going chest compressions. While simulation work suggests decreased pause times using this technique, little is known about its utilization and effects in clinical practice.
METHODS: We conducted a multicenter, retrospective study of defibrillator charging and shock administration during consecutive in-hospital cardiac arrests at three US academic teaching hospitals between April 2006 and April 2009. Charge, pause and shock times were abstracted from CPR-sensing defibrillator transcripts. Pre-shock pause and total pause times in the 60-seconds preceding the shock were compared between the two techniques. Transcripts and audio recordings were reviewed for unintended consequences, including erroneous shocks to patients and/or rescuers.
RESULTS: A total of 675 charge-cycles from 244 cardiac arrests were analyzed. The defibrillator was charged during ongoing chest compressions in 432/675 (64.0%) instances but the use of the technique varied widely among the three institutions, from 42/102 (41.1%) to 328/470 (69.8%). Shocks were administerd in 557/675 (82.5%) charge-cycles for VF/VT (71.4%), PEA (25.6%), asystole (1.9%), and perfusing rhythms (1.0%). Charging during compressions correlated with a decrease in median pre-shock pause duration [2.7 s (IQR 1.9–3.8) vs 13.3 s (IQR 8.3–19.3); p<0.0001] as well as a total decrease in hands-off time in the 60 seconds preceding defibrillation [10.8 s (IQR 7.7–13.7) vs 16.1 s (IQR 11.2–24.1); p<0.0001]. The incidence of inappropriate shocks was similar between the two groups [19.0% vs 15.7%, p=0.32] and no rescuers were inadvertently shocked in either group.
CONCLUSIONS: Charging during compressions is underutilized in clinical practice. Its use is associated with decreased pre-shock pauses and total hands-off duration preceding defibrillation, without any increase in inappropriate shocks to patients or rescuers.
This research has received full or partial funding support from the American Heart Association, National Center.