Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study.
BACKGROUND
Pauses in chest compressions during cardiopulmonary resuscitation have been shown to correlate with poor outcomes. In an attempt to minimize these pauses, the American Heart Association recommends charging the defibrillator during chest compressions. While simulation work suggests decreased pause times using this technique, little is known about its use in clinical practice.


METHODS
We conducted a multi-center, retrospective study of defibrillator charging at three US academic teaching hospitals between April 2006 and April 2009. Data were abstracted from CPR-sensing defibrillator transcripts. Pre-shock pauses and total hands-off time preceding the defibrillation attempts were compared among techniques.


RESULTS
A total of 680 charge-cycles from 244 cardiac arrests were analyzed. The defibrillator was charged during ongoing chest compressions in 448 (65.9%) instances with wide variability across the three sites. Charging during compressions correlated with a decrease in median pre-shock pause [2.6s (IQR 1.9-3.8) vs 13.3s (IQR 8.6-19.5); p < 0.001] and total hands-off time in the 30s preceding defibrillation [10.3s (IQR 6.4-13.8) vs 14.8s (IQR 11.0-19.6); p < 0.001]. The improvement in hands-off time was most pronounced when rescuers charged the defibrillator in anticipation of the pause, prior to any rhythm analysis. There was no difference in inappropriate shocks when charging during chest compressions (20.0% vs 20.1%; p = 0.97) and there was only one instance noted of inadvertent shock administration during compressions, which went unnoticed by the compressor.


CONCLUSIONS
Charging during compressions is underutilized in clinical practice. The technique is associated with decreased hands-off time preceding defibrillation, with minimal risk to patients or rescuers.
Edelson
Dana P
DP
Section of Hospital Medicine and Emergency Resuscitation Center, University of Chicago, Chicago, IL, USA. dperes@uchicago.edu
Robertson-Dick
Brian J
BJ
Yuen
Trevor C
TC
Eilevstjønn
Joar
J
Walsh
Deborah
D
Bareis
Charles J
CJ
Vanden Hoek
Terry L
TL
Abella
Benjamin S
BS
D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock / Q000295:instrumentation*; D004869:Equipment Safety; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States
Resuscitation. 1999 Jul;41(2):133-44
10488935
Circulation. 2002 Jul 16;106(3):368-72
12119255
Resuscitation. 2009 Apr;80(4):395-401
19211180
Arch Intern Med. 2008 May 26;168(10):1063-9
18504334
Circulation. 2006 Dec 19;114(25):2760-5
17159062
Resuscitation. 2009 Apr;80(4):458-62
19185411
Resuscitation. 2007 Apr;73(1):109-14
17223245
Resuscitation. 2007 Apr;73(1):54-61
17258853
JAMA. 2005 Jan 19;293(3):299-304
15657322
BMC Med. 2009 Feb 06;7:6
19200355
Resuscitation. 2005 Dec;67 Suppl 1:S39-86
16321716
Circulation. 2009 Sep 29;120(13):1241-7
19752324
Resuscitation. 2005 Mar;64(3):269-77
15733753
Resuscitation. 2003 Sep;58(3):249-58
12969599
Circulation. 2008 Dec 2;118(23):e712; author reply e713
19047587
Circulation. 2002 May 14;105(19):2270-3
12010909
Circulation. 2000 Oct 10;102(15):1780-7
11023932
Resuscitation. 2004 May;61(2):131-41
15135189
Resuscitation. 2006 Nov;71(2):137-45
16982127
JAMA. 2005 Jan 19;293(3):305-10
15657323
Circulation. 2005 Dec 13;112(24 Suppl):IV1-203
16314375
Resuscitation. 2005 Nov-Dec;67(2-3):305-14
16324994
Circulation. 2008 May 13;117(19):2435-6
18474823
Resuscitation. 2008 Feb;76(2):285-90
17728041
Circulation. 2008 May 13;117(19):2510-4
18458166
Crit Care Med. 1997 May;25(5):733-6
9187589
Resuscitation. 2007 Oct;75(1):60-7
17467139