![]() Therefore pre-charging should take place within this set time frame prior to a rhythm check. Of note, current defibrillators will “hold” the shock for some time (~60 seconds), and if the shock is not delivered in this time frame, the charge will dissipate and require re-charging. If the rhythm check happens to reveal a non-shockable rhythm, CPR can continue as per usual without any alteration. Image Modified from Note: not only is the shock delivered earlier but the second interruption is avoided completely. Image Modified from The exact decrease in perfusion pressure for a specific time period is obviously variable, but this pictorial gives you an idea of the sequence of events and highlights the delay in shock delivery and the resulting detriment in not just one, but two interruptions in chest compressions.īy pre-charging the defibrillator during the active chest compression phase of CPR, encountering a shockable rhythm at the rhythm check plays out like this: After the patient is ‘clear,’ the second provider gives a single shock as quickly as possible to minimize the interruption in chest compressions (‘hands-off interval’).” Once the defibrillator is charged, CPR is paused to ‘clear’ the patient for shock delivery. “When a rhythm check by a manual defibrillator reveals VF/VT, the first provider should resume CPR while the second provider charges the defibrillator. So why has an illogical sequence of events become standard care in CPR? The answer is simple: it’s because that’s the way CPR has always been taught per ACLS. With the defibrillator already charged and ready to go, if a shockable rhythm is encountered at rhythm check, the shock can be delivered immediately without any delay and importantly – a second interruption can be averted entirely. Charging the defibrillator prior to the rhythm check is far more logical. Why should we wait until a shockable rhythm is encountered at the rhythm check to charge the defibrillator? This makes very little sense. Pre-charging the defibrillator during the active chest compression phase of CPR, in anticipation of a shockable rhythm at the rhythm check. Instead, I would like to focus on what I believe to be a simple maneuver that based on existing evidence and simple logic should be implemented as standard care: I am not going to get into this debate here as it has already been discussed on REBEL EM. There has been much debate as to whether this practice is safe for the provider or not. Realizing the vital importance of minimizing pauses in chest compressions, it has recently become popular for providers to go as far as continuing to perform chest compressions during defibrillation (“hands-on defibrillation”) – the goal being to effectively eliminate the additional interruption. Once the defibrillator has finished charging, providers are then forced to pause yet again in order to deliver the shock. In the meantime, chest compressions are typically resumed while waiting for the defibrillator to charge. Traditionally when a shockable rhythm is encountered at the rhythm check, providers will charge the uncharged defibrillator at that time. It has been well established that longer pre- and peri-shock pauses are independently associated with decreased chance of survival. ![]() One particular aspect of CPR that has gotten a lot of attention in this regard is the peri-shock period. ![]() Why? Because we know interruptions are bad. In fact, this concept has become a major focus of the current AHA Guidelines. Post Written By: Sam Ghali (Twitter: cardiac arrest care there has been a lot of focus over the years on limiting interruptions in chest compressions during CPR.
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