Automated external defibrillators: to what extent does the algorithm delay CPR?
STUDY OBJECTIVE: Maximizing cardiopulmonary resuscitation (CPR) during resuscitation may improve survival. Resuscitation protocols stack up to 3 shocks to achieve defibrillation, followed by an immediate postdefibrillation pulse check. The purpose of this study is to evaluate outcomes of rhythm rean...
| Publicado en: | Annals of Emergency Medicine Vol. 46; no. 2; pp. 132 - 142 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Elsevier B.V.
Aug2005
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106400640&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106400640 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01960644 1WN jtl: Annals of Emergency Medicine issn: 01960644 maglogo: N pubinfo: dt: Aug2005 vid: 46 iid: 2 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 106400640 106400640 2009018822 10.1016/j.annemergmed.2005.04.001 NLM16046942 106400640 ppf: 132 ppct: 10 formats: tig: atl: Automated external defibrillators: to what extent does the algorithm delay CPR? aug: au: Rea TD Shah S Kudenchuk PJ Copass MK Cobb LA affil: Public Health Seattle & King County, Emergency Medical Services Division, 999 Third Avenue, Suite 700, Seattle, WA 98104-4039; rea123@u.washington.edu sug: subj: Defibrillators, Automated External Resuscitation, Cardiopulmonary Methods Heart Arrest Therapy Ventricular Fibrillation Therapy Ventricular Fibrillation Physiopathology Pulse Electrocardiography Treatment Outcomes Heart Arrest Physiopathology Emergency Medical Services Nonexperimental Studies Descriptive Statistics Data Analysis Software Funding Source Human ab: STUDY OBJECTIVE: Maximizing cardiopulmonary resuscitation (CPR) during resuscitation may improve survival. Resuscitation protocols stack up to 3 shocks to achieve defibrillation, followed by an immediate postdefibrillation pulse check. The purpose of this study is to evaluate outcomes of rhythm reanalyses immediately after shock, stacked shocks, and initial postshock pulse checks in relation to achieving a pulse and initiating CPR. METHODS: We conducted an observational study of patients with ventricular fibrillation treated by first-tier emergency medical services (EMS). We collected data from EMS, dispatch, and hospital records. Additionally, we analyzed automatic external defibrillator recordings to determine the proportion of cardiac arrest victims who were defibrillated and achieved a pulse according to shock number (single versus stacked shock), proportion of victims with a pulse during the initial postdefibrillation pulse check, and interval from initial shock to CPR. RESULTS: The study included 481 cardiac arrest subjects. Automatic external defibrillators terminated ventricular fibrillation with the initial shock in 83.6% (n=402) of cases. A second shock terminated ventricular fibrillation in an additional 7.5% (n=36) of cases, and a third shock terminated ventricular fibrillation in 4.8% (n=23) of cases. The initial sequence of 3 shocks failed to terminate ventricular fibrillation in 4.1% (n=20) of cases. In total, automatic external defibrillators performed 560 rhythm reanalyses during the initial shock sequence and delivered 122 'stacked' shocks. Termination of ventricular fibrillation was not synonymous with return of a pulse. The initial shock produced a pulse that was eventually detected in 21.8% (105/481) of cases. Stacked shocks produced a pulse in 10.7% (13/122) of cases. For the 24.5% (n=118) of cases in which a pulse returned, the pulse was detected during the initial postshock pulse check only 12 times, or 2.5% of all cases. The median interval from initial shock until CPR was 29 (23,41) seconds. CONCLUSION: Rhythm reanalyses, stacked shocks, and postshock pulse checks had low yield for achieving or detecting return of a pulse. CPR was not initiated until 29 seconds after the initial shock. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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