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Resuscitation. 2015 Aug;93:158-63. doi: 10.1016/j.resuscitation.2015.04.023. Epub 2015 Apr 28.

Pre-shock chest compression pause effects on termination of ventricular fibrillation/tachycardia and return of organized rhythm within mechanical and manual cardiopulmonary resuscitation.

Author information

1
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: janao@janao.info.
2
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
3
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; University of Oslo, Medical Student Research Program, University of Oslo, Oslo, Norway.
4
Houston Fire Department and the Baylor College of Medicine, Houston, TX, United States.
5
Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
6
Hillsborough County Fire Rescue, Tampa, FL, United States.
7
Gold Cross Ambulance Service, Appleton Neenah-Menasha and Grand Chute Fire Departments, WI, United States; Theda Clark Regional Medical Center, Neenah, WI, United States.
8
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
9
Heart Lung Center, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
10
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.

Abstract

BACKGROUND:

Shorter manual chest compression pauses prior to defibrillation attempts is reported to improve the defibrillation success rate. Mechanical load-distributing band (LDB-) CPR enables shocks without compression pause. We studied pre-shock pause and termination of ventricular fibrillation/pulseless ventricular tachycardia 5s post-shock (TOF) and return of organized rhythm (ROOR) with LDB and manual (M-) CPR.

METHODS:

In a secondary analysis from the Circulation Improving Resuscitation Care trial, patients with initial shockable rhythm and interpretable post-shock rhythms were included. Pre-shock rhythm, pause duration (if any), and post-shock rhythm were obtained for each shock. Associations between TOF/ROOR and pre-shock pause duration, including no pause shocks with LDB-CPR, were analyzed with Chi-square test. A p-value <0.05 was considered statistically significant.

RESULTS:

For TOF and ROOR analyses we included 417 LDB-CPR patients with 1476 and 1438 shocks, and 495 M-CPR patients with 1839 and 1796 shocks, respectively. For first shocks with LDB-CPR, pre-shock pause was associated with TOF (p=0.049) with lowest TOF (77%) for shocks given without pre-shock compression pause. This association was not significant when all shocks were included (p=0.07) and not for ROOR. With M-CPR there were no significant associations between shock-related chest compression pause duration and TOF or ROOR.

CONCLUSION:

For first shocks with LDB-CPR, termination of fibrillation was associated with pre-shock pause duration. There was no association for the rate of return of organized rhythm. For M-CPR, where no shocks were given during continuous chest compressions, there were no associations between pre-shock pause duration and TOF or ROOR.

KEYWORDS:

CPR; Cardiac arrest; Defibrillation; Emergency medical services; Mechanical CPR

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