title: The Stop-Only-While-Shocking algorithm reduces hands-off time by 17% during cardiopulmonary resuscitation - a simulation study.
abstract: BACKGROUND
  Reducing hands-off time during cardiopulmonary resuscitation (CPR) is believed to increase survival after cardiac arrests because of the sustaining of organ perfusion. The aim of our study was to investigate whether charging the defibrillator before rhythm analyses and shock delivery significantly reduced hands-off time compared with the European Resuscitation Council (ERC) 2010 CPR guideline algorithm in full-scale cardiac arrest scenarios.
  
  
  METHODS
  The study was designed as a full-scale cardiac arrest simulation study including administration of drugs. Participants were randomized into using the Stop-Only-While-Shocking (SOWS) algorithm or the ERC2010 algorithm. In SOWS, chest compressions were only interrupted for a post-charging rhythm analysis and immediate shock delivery. A Resusci Anne HLR-D manikin and a LIFEPACK 20 defibrillator were used. The manikin recorded time and chest compressions.
  
  
  RESULTS
  Sample size was calculated with an α of 0.05 and 80% power showed that we should test four scenarios with each algorithm. Twenty-nine physicians participated in 11 scenarios. Hands-off time was significantly reduced 17% using the SOWS algorithm compared with ERC2010 [22.1% (SD 2.3) hands-off time vs. 26.6% (SD 4.8); P<0.05].
  
  
  CONCLUSIONS
  In full-scale cardiac arrest simulations, a minor change consisting of charging the defibrillator before rhythm check reduces hands-off time by 17% compared with ERC2010 guidelines.
authors.affiliation: aDepartment of Gastroenterology and Hepatology, Vejle Hospital, a part of Lillebaelt Hospital, Vejle bDepartment of Pulmonary diseases, Bispebjerg Hospital, Copenhagen cCentre of Cancer Immunotherapy, Herlev Hospital, Herlev dDepartment of Emergency Medicine, Hospital of South-West Jutland, Esbjerg Departments of eEndocrinology fGastroenterology and Hepatology gCardiology hClinical Chemistry and Pharmacology iEmergency Medicine, Odense University Hospital jDepartment of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Koch Hansen
authors.forename: Anna
authors.initials: A
authors.lastname: Mohammed
authors.forename: Magnus
authors.initials: M
authors.lastname: Pedersen
authors.forename: Lars
authors.initials: L
authors.lastname: Folkestad
authors.forename: Jacob
authors.initials: J
authors.lastname: Brodersen
authors.forename: Thomas
authors.initials: T
authors.lastname: Hey
authors.forename: Nicolaj
authors.initials: N
authors.lastname: Lyhne Christensen
authors.forename: Rasmus
authors.initials: R
authors.lastname: Carter-Storch
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Bendix
authors.forename: Morten R
authors.initials: MR
authors.lastname: Hansen
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
mesh_terms: D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock / Q000379:methods; D006323:Heart Arrest / Q000628:therapy; D006336:Heart Massage / Q000379:methods; D006801:Humans; D008348:Manikins