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In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome . There has also been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus akgoritmos the current AHA Guidelines. Because we know interruptions are bad [2,3].
One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival [4,5]. Can we do better to shock sooner and minimize these pauses?
Traditionally during manual CPR when a shockable rhythm is encountered at the rhythm check, providers will charge the uncharged defibrillator at that time. In the meantime, chest compressions are typically resumed while waiting for the defibrillator to charge. Once a shockable rhythm is identified, there is a delay in shock delivery while awaiting defibrillator charging.
There is not just 1 but 2 interruptions in chest compressions. The exact decrease in perfusion algritmos during these pauses is variable.
Saiba como reduzir o tempo sem compressão na RCP
Pre-charge the defibrillator during the active chest compression phase of CPR in anticipation of a shockable rhythm. Why should we wait until a shockable rhythm is encountered at the rhythm check point to charge the defibrillator?
This makes little sense. Charging the defibrillator prior to the rhythm check is far more logical. Not only is als shock delivered earlier but the second interruption seen in Figure 1 is avoided completely.
The most important key to ensuring this process runs smoothly lies in preparation and team briefing prior to patient arrival. There must be clear understanding and communication. The timekeeper is tasked with announcing prior to all adls checks seconds prior is reasonable that the rhythm check is approaching. At this point the team member running the defibrillator charges the defibrillator as chest compressions continue uninterrupted until the rhythm check. With the defibrillator pre-charged, the team is armed and ready to combat a shockable rhythm immediately as it is encountered at the rhythm check.
If the rhythm check happens to reveal a non-shockable rhythm, CPR can continue as per usual without any alteration. This is why pre-charging should take place within this set time period prior to a rhythm check.
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Simply test your particular defibrillator to figure out exactly how long it holds the 2100. The only arguments I have ever heard against the implementation of this strategy is that it may acks the incidence of inappropriate or inadvertent shocks.
Presumably, these theoretical concerns have prevented this technique from being recommended as standard practice. Data were gathered from CPR-sensing defibrillator transcripts over a 3-year period. They looked at charge-cycles from cardiac arrests. Charging during compressions correlated with a decrease in median aclx pause and total hands-off time in the 30 seconds preceding defibrillation. Interestingly, there was no difference in inappropriate shocks, and there was only one instance of inadvertent shock administration during compressions which went unnoticed by the compressor.
There will likely never be robust data looking at this particular aspect of CPR. Pre-charging the defibrillator is a small thing, but with potentially huge impact. It can be easily taught, easily learned, and is free. I have personally been practicing CPR this way for years now. It has been my experience that it is an incredibly smooth process.
All it takes is a little practice and team briefing to ensure all providers are on the aclss page. Does it improve outcomes?
We may never definitively know.
Will it ever make the guidelines? I suspect that eventually it will, perhaps with verbiage similar to something like this:. Until then, it is my opinion that based on early literature, logic, and reasoning, pre-charging the defibrillator in anticipation of a shockable rhythm at the rhythm check is how we should be running xlgoritmos codes.
Pre-Charge the Defibrillator In cardiac arrest care it is well accepted that time to defibrillation is closely correlated with survival and outcome . Pre-charge the defibrillator during the active chest compression phase of CPR in anticipation of a shockable rhythm Why should we wait until a shockable rhythm is encountered at the rhythm check point to charge the defibrillator?
I suspect that eventually it will, perhaps with verbiage similar to something like this: Delayed time to defibrillation after in-hospital cardiac arrest.
N Engl J Med. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Cardiopulmonary resuscitation for cardiac arrest: Am J Emerg Med ; 30 8: Safety and efficacy of defibrillator charging during ongoing chest compressions: