title: Association Between Chest Compression Interruptions and Clinical Outcomes of Ventricular Fibrillation Out-of-Hospital Cardiac Arrest.
abstract: BACKGROUND
  Minimizing pauses in chest compressions during cardiopulmonary resuscitation is a focus of current guidelines. Prior analyses found that prolonged pauses for defibrillation (perishock pauses) are associated with worse survival. We analyzed resuscitations to characterize the association between pauses for all reasons and both ventricular fibrillation termination and patient survival.
  
  
  RESULTS
  In 319 patients with ventricular tachycardia/fibrillation out-of-hospital cardiac arrest, we analyzed recordings from all defibrillators used during resuscitation and measured durations of all cardiopulmonary resuscitation pauses. Median durations were 32 seconds (25th and 75th percentile, 22 and 52 seconds) for the longest pause for any reason, 23 seconds (25th and 75th percentile, 14 and 34 seconds) for the longest perishock pause, and 24 seconds (25th and 75th percentile, 11 and 38 seconds) for the longest nonshock pause. Multivariable regression models showed lower odds for survival per 5-second increase in the longest overall pause (odds ratio, 0.89; 95% confidence interval, 0.83-0.95), longest perishock pause (odds ratio, 0.85; 95% confidence interval, 0.77-0.93), and longest nonshock pause (odds ratio, 0.83; 95% confidence interval, 0.75-0.91). In 36% of cases, the longest pause was a nonshock pause; this subgroup had lower survival than the group in whom the longest pause was a perishock pause (27% versus 44%, respectively; P<0.01) despite a higher chest compression fraction. Preshock pauses were 8 seconds (25th and 75th percentile, 4 and 17 seconds) for shocks that terminated ventricular fibrillation and 7 seconds (25th and 75th percentile, 4 and 13 seconds) for shocks that did not (P=0.18).
  
  
  CONCLUSIONS
  Prolonged pauses have a negative association with survival not explained by chest compression fraction or decreased ventricular fibrillation termination rate. Ventricular fibrillation termination was not the mechanism linking pause duration and survival. Strategies shortening the longest pauses may improve outcome.
authors.affiliation: From Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (T.F.B., R.W.K.); and Physio-Control, Inc, Redmond, WA (R.G.W., F.W.C.). t.f.brouwer@amc.uva.nl.
authors.forename: Tom F
authors.initials: TF
authors.lastname: Brouwer
authors.affiliation: From Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (T.F.B., R.W.K.); and Physio-Control, Inc, Redmond, WA (R.G.W., F.W.C.).
authors.forename: Robert G
authors.initials: RG
authors.lastname: Walker
authors.affiliation: From Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (T.F.B., R.W.K.); and Physio-Control, Inc, Redmond, WA (R.G.W., F.W.C.).
authors.forename: Fred W
authors.initials: FW
authors.lastname: Chapman
authors.affiliation: From Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (T.F.B., R.W.K.); and Physio-Control, Inc, Redmond, WA (R.G.W., F.W.C.).
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012044:Regression Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications*
keywords: cardiopulmonary resuscitation; electric countershock; heart arrest; survival