Hands On During Defibrillation: ‘I’m Not Clear!’

It’s a wonder that anyone survives — or survives neurologically intact — with all the interruptions that happen during the recognition, delivery, transfer, and treatment of a patient undergoing cardiopulmonary resuscitation.   The American Heart Association and the international resuscitation community have been constantly beating the drum in recent years about quality of chest compressions and the need to decrease interruptions that occur during cardiopulmonary resuscitation. (Circulation 2010;122[18 Suppl 3]:S706, 2010;122[18 Suppl 3]:S640, 2009;120[13]:1241; Resuscitation 2011;82[3]:263; Resuscitation 2010;81[10]:1219; Heart 2009;95[24]:1978.)   Animal studies have demonstrated that interruptions in chest compressions decrease coronary and cerebral blood flow and worsen survival outcomes. (Circulation 2001;104[20]:2465, 2007;116[22]:2525.) Even pausing a few seconds reduces the chances that the defibrillation shock will be successful. (Circulation 2002;105[19]:2270, Circulation 2004;110[1]:10; Resuscitation 2006;71[2]:137.)   Nevertheless, interruptions still continue to occur for intubation, ventilations, AED analyses, charging, and defibrillation shocks. The latest European guidelines recommend continued chest compressions while charging the defibrillator. Those guidelines, however, still recommend chest compressions be briefly paused and all rescuers cleared of the patient once the defibrillator is charged. (Resuscitation2010;81[10]:1219.) Lloyd et al analyzed ...
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