title: Defibrillation delivered during the upstroke phase of manual chest compression improves shock success.
abstract: OBJECTIVE
  The current standard of manual chest compression during cardiopulmonary resuscitation requires pauses for rhythm analysis and shock delivery. However, interruptions of chest compression greatly decrease the likelihood of successful defibrillations, and significantly better outcomes are reported if this interruption is avoided. We therefore undertook a prospective randomized controlled animal study in an electrically induced ventricular fibrillation pig model to assess the effects of timing of defibrillation on the manual chest compression cycle on the defibrillation threshold.
  
  
  METHODS
  Prospective, randomized, controlled animal study.
  
  
  METHODS
  University-affiliated research laboratory.
  
  
  METHODS
  Yorkshire-X domestic pigs (Sus scrofa).
  
  
  METHODS
  In eight domestic male pigs weighing between 24 and 31 kg, ventricular fibrillation was electrically induced and untreated for 10 secs. Manual chest compression was then performed and continued for 25 secs with the protection of an isolation blanket. The depth and frequency of chest compressions were guided by a cardiopulmonary resuscitation prompter. Animals were randomized to receive a biphasic electrical shock in five different compression phases with a predetermined energy setting. A control phase was chosen at a constant 2 secs after discontinued chest compression. A grouped up-down defibrillation threshold testing protocol was used to compare the success rate at different coupling phases. After a recovery interval of 4 mins, the sequence was repeated for a total of 60 test shocks for each animal.
  
  
  RESULTS
  No difference in coronary perfusion pressure before delivering of the shock was observed among the six study phases. The defibrillation success rate, however, was significantly higher when shocks were delivered in the upstroke phase of manual chest compression.
  
  
  CONCLUSIONS
  Defibrillation efficacy is maximal when electrical shock is delivered during the upstroke phase of manual chest compression.
authors.affiliation: Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA.
authors.forename: Yongqin
authors.initials: Y
authors.lastname: Li
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Jun Hwi
authors.initials: JH
authors.lastname: Cho
authors.forename: Weilun
authors.initials: W
authors.lastname: Quan
authors.forename: Gary
authors.initials: G
authors.lastname: Freeman
authors.forename: Joe
authors.initials: J
authors.lastname: Bisera
authors.forename: Max Harry
authors.initials: MH
authors.lastname: Weil
authors.forename: Wanchun
authors.initials: W
authors.lastname: Tang
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock; D006336:Heart Massage / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D013552:Swine; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology*