title: Hands-on defibrillation and electrocardiogram artefact filtering technology increases chest compression fraction and decreases peri-shock pause duration in a simulation model of cardiac arrest.
abstract: BACKGROUND
  Reducing pauses during cardiopulmonary resuscitation (CPR) compressions result in better outcomes in cardiac arrest. Artefact filtering technology (AFT) gives rescuers the opportunity to visualize the underlying electrocardiogram (ECG) rhythm during chest compressions, and reduces the pauses that occur before and after delivering a shock. We conducted a simulation study to measure the reduction of peri-shock pause and impact on chest compression fraction (CCF) through AFT.
  
  
  METHODS
  In a simulator setting, participants were given a standardized cardiac arrest scenario and were randomly assigned to perform CPR/defibrillation using the protocol from one of three experimental arms: 1) Standard of Care (pauses for rhythm analysis and shock delivery); 2) AFT (no pauses for rhythm analysis, but a pause for defibrillation); or 3) AFT with hands-on defibrillation (no pauses for rhythm analysis or defibrillation). The primary outcomes were CCF and peri-shock pause duration, with secondary outcomes of pre- and post-shock pause duration.
  
  
  RESULTS
  AFT with hands-on defibrillation was found to have the highest CCF (86.4%), as compared to AFT alone (83.8%, p<0.001), and both groups significantly improved CCF in comparison with the Standard of Care (76.7%, p<0.001). AFT with hands-on defibrillation was associated with a reduced peri-shock pause (2.6 seconds) as compared to AFT alone (5.3 seconds, p<0.001), and the Standard of Care (7.4 seconds, p<0.001).
  
  
  CONCLUSIONS
  In this cardiac arrest model, AFT results in a greater CCF by reducing peri-shock pause duration. There is also a small but detectable improvement in CCF with the addition of hands-on defibrillation.
authors.affiliation: *Kingston Resuscitation Institute,Kingston,ON.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Fernando
authors.affiliation: ‡Sunnybrook Centre for Prehospital Medicine,Department of Family and Community Medicine,Division of Emergency Medicine,University of Toronto,Toronto,ON.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Cheskes
authors.affiliation: *Kingston Resuscitation Institute,Kingston,ON.
authors.forename: Daniel
authors.initials: D
authors.lastname: Howes
mesh_terms: D016477:Artifacts; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D011930:Reaction Time; D012769:Shock / Q000503:physiopathology / Q000517:prevention & control; D000066908:Simulation Training / Q000379:methods*; D013647:Task Performance and Analysis
keywords: cardiac arrest; cardiopulmonary resuscitation; chest compression fraction; defibrillation; perishock pause