title: Chest compressions cause recurrence of ventricular fibrillation after the first successful conversion by defibrillation in out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Unlike Resuscitation Guidelines (GL) 2000, GL2005 advise resuming cardiopulmonary resuscitation (CPR) immediately after defibrillation. We hypothesized that immediate CPR resumption promotes earlier recurrence of ventricular fibrillation (VF).
  
  
  RESULTS
  This study used data of a prospective per-patient randomized controlled trial. Automated external defibrillators used by first responders were randomized to either (1) perform postshock analysis and prompt rescuers to a pulse check (GL2000), or (2) resume CPR immediately after defibrillation (GL2005). Continuous recordings of ECG and impedance signals were collected from all patients with an out-of-hospital cardiac arrest to whom a randomized automated external defibrillator was applied. We included patients with VF as their initial rhythm in whom CPR onset could be determined from the ECG and impedance signals. Time intervals are presented as median (Q1-to-Q3). Of 361 patients, 136 met the inclusion criteria: 68 were randomly assigned to GL2000 and 68 to GL2005. Rescuers resumed CPR 30 (21-to-39) and 8 (7-to-9) seconds, respectively, after the first shock that successfully terminated VF (P<0.001); VF recurred after 40 (21-to-76) and 21 (10-to-80) seconds, respectively (P=0.001). The time interval between start of CPR and VF recurrence was 6 (0-to-67) and 8 (3-to-61) seconds, respectively (P=0.88). The hazard ratio for VF recurrence in the first 2 seconds of CPR was 15.5 (95% confidence interval, 5.63 to 57.7) compared with before CPR resumption. After more than 8 seconds of CPR, the hazard of VF recurrence was similar to before CPR resumption.
  
  
  CONCLUSIONS
  Early CPR resumption after defibrillation causes early VF recurrence. Clinical Trial Registration- clinicaltrials.gov Identifier: ISRCTN72257677.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. J.Berdowski@amc.nl
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Berdowski
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D004554:Electric Countershock; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology