title: Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study.
abstract: 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.
authors.affiliation: Section of Hospital Medicine and Emergency Resuscitation Center, University of Chicago, Chicago, IL, USA. dperes@uchicago.edu
authors.forename: Dana P
authors.initials: DP
authors.lastname: Edelson
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Robertson-Dick
authors.forename: Trevor C
authors.initials: TC
authors.lastname: Yuen
authors.forename: Joar
authors.initials: J
authors.lastname: Eilevstjønn
authors.forename: Deborah
authors.initials: D
authors.lastname: Walsh
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bareis
authors.forename: Terry L
authors.initials: TL
authors.lastname: Vanden Hoek
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
mesh_terms: 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
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