Abstract 181: A Protocol Advocating a Brief Preshock Confirmatory Pause for Use with ECG Filtration Software Improves Defibrillation Accuracy in Cardiac Arrest
Background: Current cardiopulmonary arrest (CPA) algorithms suggest compression pauses for rhythm analysis every 2 minutes. However, this may dramatically decrease chest compression fraction (CCF) values and coronary perfusion pressures. ECG filtration software is available but is associated with a measurable incidence of defibrillation attempts on non-shockable rhythms.
Objective: To evaluate the impact of a novel protocol advocating a brief confirmatory pre-shock compression pause for suspected ventricular tachycardia or ventricular fibrillation (VT/VF).
Methods: This was a pre/post analysis conducted in two academic inpatient facilities with approximately 500 total beds. Our institution implemented ECG filtration software (Zoll Corp) in May 2009. Adult CPA victims with at least one defibrillation attempt were identified. Defibrillator data was exported for CCF values, pre-/post-shock pause duration, and pre-shock rhythm. In April 2011, a novel protocol was implemented advocating a brief confirmatory pre-shock pause for arrest victims with suspected VT/VF (within 30 seconds of defibrillation). Defibrillation accuracy (attempted defibrillation of VF/VT) was determined before and after the novel protocol change (effectiveness analysis) and in patients with and without a brief pre-shock pause (efficacy analysis). CCF, incidence of pre-shock pause values <=5 sec, and survival among VF/VT arrest victims before/after the protocol change were determined.
Results: A total of 127 defibrillation attempts in 45 patients were included. Defibrillation accuracy before and after the protocol change was 65% vs. 86%, respectively (p=0.031). Defibrillation accuracy in patients without and with a pre-shock confirmatory pause was 44% vs. 94%, respectively (p<0.001). Survival among patients with primary VF/VT before and after the protocol change was 19% versus 53%, respectively (p=0.016). CCF values and the incidence of pre-shock pause values <=5 sec were unchanged (89% vs. 76%, p=NS).
Conclusion: A protocol for use with ECG filtration software advocating a brief pre-shock confirmatory pause improves defibrillation accuracy without diminishing CCF or pre-shock pause values. Improvement in survival was also observed.
- © 2012 by American Heart Association, Inc.