Document Detail


Minimizing Pre-shock Chest Compression Pauses in a Cardiopulmonary Resuscitation Cycle by Performing an Earlier Rhythm Analysis.
MedLine Citation:
PMID:  25461493     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Guidelines recommend two minutes of CPR after defibrillation attempts followed by ECG analysis during chest compression pause. This pause may reduce the likelihood of return of spontaneous circulation (ROSC) and survival. We have evaluated the possibility of analysing the rhythm earlier in the CPR cycle in an attempt to replace immediate pre-shock rhythm analysis.
METHODS AND RESULTS: The randomized Circulation Improving Resuscitation Care (CIRC) trial included patients with out of hospital cardiac arrest of presumed cardiac aetiology. Defibrillator data were used to categorize ECG rhythms as shockable or non-shockable one minute post-shock and immediately before next shock. ROSC was determined from end-tidal CO2, transthoracic impedance (TTI), and patient records. TTI was used to identify chest compressions. Artefact free ECGs were categorized during periods without chest compressions. Episodes without ECG or TTI data or with undeterminable ECG rhythm were excluded. Data were analysed using descriptive statistics. Of 1657 patients who received 3409 analysable shocks, the rhythm was shockable in 1529 (44.9%) cases one minute post-shock, 13 (0.9%) of which were no longer shockable immediately prior to next possible shock. Of these, three had converted to asystole, seven to PEA and three to ROSC.
CONCLUSION: While a shockable rhythm one minute post-shock was present also immediately before next possible defibrillation attempt in most cases, three patients had ROSC. Studies are needed to document if moving the pre-shock rhythm analysis will increase shocks delivered to organized rhythms, and if it will increase shock success and survival.
Authors:
Mikkel T Steinberg; Jan-Aage Olsen; Cathrine Brunborg; David Persse; Fritz Sterz; Michael Lozano Jr; Marc A Brouwer; Mark Westfall; Chris M Souders; Pierre M van Grunsven; David T Travis; E Brooke Lerner; Lars Wik
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-21
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  Resuscitation     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-2     Completed Date:  -     Revised Date:  2014-12-3    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014. Published by Elsevier Ireland Ltd.
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