title: When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers.
abstract: BACKGROUND
  Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest.
  
  
  METHODS
  We conducted an observational study in which a Web-based survey was sent to ACLS-trained medical providers at 4 major urban tertiary care centers in the United States. The survey consisted of 5 multiple-choice, scenario-based ACLS questions, including our question of interest. Adult staff members with a valid ACLS certification were included.
  
  
  RESULTS
  A total of 347 surveys were analyzed. The response rate was 28.1%. The majority (53.6%) of responders were between 18 and 32 years old, and 59.9% were female. The majority (54.2%) of responders incorrectly stated that they would continue CPR and possibly administer additional therapies when a team member detects a pulse immediately following defibrillation. Secondarily, only 51.9% of respondents correctly chose to perform a rhythm check following 2 minutes of CPR. The other 3 survey questions were correctly answered an average of 89.1% of the time.
  
  
  CONCLUSIONS
  Confusion exists regarding whether or not CPR and cardiac medications should be continued in the presence of a pulse. Education may be warranted to emphasize avoiding compressions and medications when a palpable pulse is detected.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Giberson
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Uber
authors.affiliation: Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: F Gaieski
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Miller
authors.affiliation: Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Wira
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Giberson
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: S Abella
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Medicine, Division of Pulmonary, Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA mdonnino@bidmc.harvard.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D008297:Male; D011674:Pulse; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014481:United States; D055815:Young Adult
keywords: CPR; cardiac arrest; cardiopulmonary arrest; guidelines