Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm. (December 2021)

• Record Type: Journal Article
• Authors: Iversen, Bo Nees; Meilandt, Carsten; Væggemose, Ulla; Terkelsen, Christian Juhl; Kirkegaard, Hans; Fjølner, Jesper
• Is Part Of: Resuscitation. Volume 169(2021)
• Page Start: 23
• Page End: 30
• Publication Date: 2021-12
• Subjects: Defibrillation -- Pre-charging -- Cardiac arrest -- Shockable rhythm -- Cardiopulmonary resuscitation -- Advanced life support; TTI transthoracic impedance -- DP defibrillation procedure -- PCCA prehospital critical care anaesthesiologist; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.09.037
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: To evaluate the effect of pre-charging the defibrillator before rhythm analysis on hands-off time in patients suffering from out-of-hospital cardiac arrest with shockable rhythm. Methods: Pre-charging was implemented in the Emergency Medical Service in the Central Denmark Region in June 2018. Training consisted of hands-on simulation scenarios, e-learning material, and written instructions. Data were extracted from the Danish Cardiac Arrest Registry for a 14-month period spanning the implementation of pre-charging. Patients having received at least one shock were included. Transthoracic impedance data were analysed. We recorded hands-off time and peri-shock pauses for all defibrillation procedures and the total hands-off fraction for all cardiac arrests. Results: Impedance and outcome data were available for 178 patients. 523 defibrillation procedures were analysed. The pre-charge method was associated with shorter median hands-off time per defibrillation procedure (7.6 (IQR 5.8–9.9) vs. 12.6 (IQR 10–16.4) seconds, p < 0.001) but longer pre-shock pause (4 (IQR 2.7–6.1) vs 1.7 (IQR 1.2–3) seconds, p < 0.001) when compared to the current guideline-recommended defibrillation method. The total hands-off fraction per cardiac arrest was reduced after implementation of the pre-charge method (16.5% vs. 20.4%, p = 0.003). No increase in shocks to non-shockable rhythms or personnel was registered. Patients who received only pre-charge defibrillations had an increased odds ratio of return of spontaneous circulation (aOR 2.91; 95%CI 1.09–7.8, p = 0.03). Conclusion: Pre-charging the defibrillator reduced hands-off time during defibrillation procedures, reduces the total hands-off fraction and may be associated with increased return of spontaneous circulation in out-of-hospital cardiac arrest with shockable rhythm.