Post-shock chest compression delays with automated external defibrillator use

Marc D Berg, Lani L. Clark, Terence D Valenzuela, Karl B Kern, Robert A. Berg

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Primary objective: In a swine model of out-of-hospital ventricular fibrillation (VF) cardiac arrest, we established that automated external defibrillator (AED) defibrillation could worsen outcome from prolonged VF compared with manual defibrillation. Worse outcomes were due to substantial interruptions and delays in chest compressions for AED rhythm analyses and shock advice. In particular, the mean interval from first AED shock to first post-shock compressions was 46 ± 6 s. We hypothesized that the delay from shock to provision of chest compressions is similar in the out-of-hospital setting. Materials and methods: We conducted a retrospective observational review of AED-treated adult VF cardiac arrest victims over a 26-month period to determine the interval from the first AED defibrillation attempt to the initial provision of post-shock chest compressions for out-of-hospital VF cardiac arrests. A two-tiered, single emergency medical service (EMS) system with AED-equipped first responders serves our area of 400 km2 with a population of 487,000 people. The defibrillators record a detailed sequence of events during the resuscitation effort that includes the electrocardiogram with real clock times and a recording of surrounding audible actions. Results: A median of 38 s (IQR 15, 61 s) elapsed between the first shock and the initiation of chest compressions. Approximately half of the delay was due to mechanical/electronic factors and the remainder due to human factors. Of 64 adults in VF, 45 (70%) died before hospital admission, 19 (30%) survived to admission and 10 (16%) survived to hospital discharge. Conclusion: Substantial delays in the provision of post-shock chest compressions are typical in this EMS system with AED-equipped first responders.

Original languageEnglish (US)
Pages (from-to)287-291
Number of pages5
JournalResuscitation
Volume64
Issue number3
DOIs
StatePublished - Mar 2005

Fingerprint

Defibrillators
Shock
Thorax
Ventricular Fibrillation
Heart Arrest
Emergency Medical Services
Resuscitation
Electrocardiography
Swine

Keywords

  • Automated external defibrillator (AED)
  • Cardiac arrest
  • Cardiopulmonary resuscitation (CPR)
  • Emergency medical services
  • Heart arrest
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Post-shock chest compression delays with automated external defibrillator use. / Berg, Marc D; Clark, Lani L.; Valenzuela, Terence D; Kern, Karl B; Berg, Robert A.

In: Resuscitation, Vol. 64, No. 3, 03.2005, p. 287-291.

Research output: Contribution to journalArticle

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abstract = "Primary objective: In a swine model of out-of-hospital ventricular fibrillation (VF) cardiac arrest, we established that automated external defibrillator (AED) defibrillation could worsen outcome from prolonged VF compared with manual defibrillation. Worse outcomes were due to substantial interruptions and delays in chest compressions for AED rhythm analyses and shock advice. In particular, the mean interval from first AED shock to first post-shock compressions was 46 ± 6 s. We hypothesized that the delay from shock to provision of chest compressions is similar in the out-of-hospital setting. Materials and methods: We conducted a retrospective observational review of AED-treated adult VF cardiac arrest victims over a 26-month period to determine the interval from the first AED defibrillation attempt to the initial provision of post-shock chest compressions for out-of-hospital VF cardiac arrests. A two-tiered, single emergency medical service (EMS) system with AED-equipped first responders serves our area of 400 km2 with a population of 487,000 people. The defibrillators record a detailed sequence of events during the resuscitation effort that includes the electrocardiogram with real clock times and a recording of surrounding audible actions. Results: A median of 38 s (IQR 15, 61 s) elapsed between the first shock and the initiation of chest compressions. Approximately half of the delay was due to mechanical/electronic factors and the remainder due to human factors. Of 64 adults in VF, 45 (70{\%}) died before hospital admission, 19 (30{\%}) survived to admission and 10 (16{\%}) survived to hospital discharge. Conclusion: Substantial delays in the provision of post-shock chest compressions are typical in this EMS system with AED-equipped first responders.",
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