BACKGROUND: Semi-automatic defibrillation requires pauses in chest compressions during ECG analysis and charging, and prolonged pre-shock compression pauses reduce the chance of a return of spontaneous circulation (ROSC). We hypothesised that pauses are shorter for manual defibrillation by trained rescuers, but with an increased number of inappropriate shocks given for a non-VF/VT rhythm. METHODS: From a prospective study of CPR quality during in- and out-of-hospital cardiac arrest, the duration of pre-shock, inter-shock, and post-shock pauses were compared with Mann-Whitney U-test during manual and AED mode with the same defibrillator, and proportions of inappropriate shocks were compared with Chi-squared tests. RESULTS: A 635 manual and 530 semi-automatic shocks were studied. Number of shocks per episode was similar for the two groups. All pauses measured in seconds (s) were shorter for manual use (P<0.0001); median (25, 75 percentiles); 15 (11, 21) versus 22 (18, 28) pre-shock, 13 (9, 20) versus 23 (22, 26) inter-shock, and 9 (6, 18) versus 20 (11, 31) post-shock, but 163 (26%) manual shocks were inappropriate compared with 30 (6%) AED shocks, odds ratio (OR) 5.7 (95% CI; 3.8-8.7). A 150 (78%) of the inappropriate shocks were delivered for organised rhythms. The proportion of inappropriate manual shocks was higher for resident physicians in-hospital than paramedics out-of-hospital; 77/228 (34%) versus 86/407 (21%), OR 1.9 (1.3-2.7). CONCLUSION: Manual defibrillation resulted in shorter pauses in chest compressions, but a higher frequency of inappropriate shocks. A higher formal level of education did not prevent inappropriate shocks. Trial registrationhttp://www.clinicaltrials.gov/ (NCT00138996 and NCT00228293).
BACKGROUND:Semi-automatic defibrillation requires pauses in chest compressions during ECG analysis and charging, and prolonged pre-shock compression pauses reduce the chance of a return of spontaneous circulation (ROSC). We hypothesised that pauses are shorter for manual defibrillation by trained rescuers, but with an increased number of inappropriate shocks given for a non-VF/VT rhythm. METHODS: From a prospective study of CPR quality during in- and out-of-hospital cardiac arrest, the duration of pre-shock, inter-shock, and post-shock pauses were compared with Mann-Whitney U-test during manual and AED mode with the same defibrillator, and proportions of inappropriate shocks were compared with Chi-squared tests. RESULTS: A 635 manual and 530 semi-automatic shocks were studied. Number of shocks per episode was similar for the two groups. All pauses measured in seconds (s) were shorter for manual use (P<0.0001); median (25, 75 percentiles); 15 (11, 21) versus 22 (18, 28) pre-shock, 13 (9, 20) versus 23 (22, 26) inter-shock, and 9 (6, 18) versus 20 (11, 31) post-shock, but 163 (26%) manual shocks were inappropriate compared with 30 (6%) AED shocks, odds ratio (OR) 5.7 (95% CI; 3.8-8.7). A 150 (78%) of the inappropriate shocks were delivered for organised rhythms. The proportion of inappropriate manual shocks was higher for resident physicians in-hospital than paramedics out-of-hospital; 77/228 (34%) versus 86/407 (21%), OR 1.9 (1.3-2.7). CONCLUSION: Manual defibrillation resulted in shorter pauses in chest compressions, but a higher frequency of inappropriate shocks. A higher formal level of education did not prevent inappropriate shocks. Trial registrationhttp://www.clinicaltrials.gov/ (NCT00138996 and NCT00228293).
Authors: C Zebuhr; R M Sutton; W Morrison; D Niles; L Boyle; A Nishisaki; P Meaney; J Leffelman; R A Berg; V M Nadkarni Journal: Resuscitation Date: 2012-02-03 Impact factor: 5.262
Authors: Sheldon Cheskes; Robert H Schmicker; Jim Christenson; David D Salcido; Tom Rea; Judy Powell; Dana P Edelson; Rebecca Sell; Susanne May; James J Menegazzi; Lois Van Ottingham; Michele Olsufka; Sarah Pennington; Jacob Simonini; Robert A Berg; Ian Stiell; Ahamed Idris; Blair Bigham; Laurie Morrison Journal: Circulation Date: 2011-06-20 Impact factor: 29.690
Authors: Johan N Siebert; Alban Glangetas; Marine Grange; Kevin Haddad; Delphine S Courvoisier; Laurence Lacroix Journal: Nurs Crit Care Date: 2021-09-13 Impact factor: 2.897