charge during chest compressions

19 Sep

When effective chest compressions and early defibrillation are probably the most important pieces in your ACLS toolbox, minimizing time off the chest during pulse/rhythm checks is paramount.

 

Too often I’ve see this in codes:

  • there’s a pause for a pulse/rhythm check,
  • and THEN if there’s a shockable rhythm seen, someone hits the charge button on the defibrillator,
  • there’s an awkward few seconds with the high-pitched whine of the defibrillator charging,
  • some shuffling of feet,
  • twiddling of thumbs…
  • and then the defibrillator mercifully beeps that’s its ready to go,
  • people shout ‘clear’, a button is hit–charge delivered,
  • and chest compressions resume.  

In truth, this is only a few seconds (e.g. Philips defib takes < 5 sec to charge), but that’s time during which no semi-oxygenated blood is circulating to the brain, and it takes a little bit to get things circulating again (think of how it takes a few stirs to get soup spinning in a pot).

How do we minimize the time off the chest?

 

CHARGE THE DEFIBRILLATOR DURING CHEST COMPRESSIONS

 

EVIDENCE:

2007 mannequin study by Perkins et al:

pre-shock pause between cessation of chest compression and shock delivery

  • charge during chest compressions: ~1.5 sec
  • charge after rhythm check: ~ 7 sec

 

 

2010 retrospective study by Edelson et al:

defibrillator was charged during ongoing chest compressions in 448 (65.9%)

pre-shock pause time

  • Charging during compressions  ~2.6 sec
  • charge after rhythm check ~13.3 sec

total hands-off time in the 30s preceding defibrillation

  • Charging during compressions  ~10.3 sec
  • charge after rhythm check ~14.8 sec

 

BOTTOM LINE:

minimize time off the chest, charge during chest compressions

Takes a little bit of forethought and some coordination, but just before your planned pulse/rhythm check, have someone hit the charge button.  

The key is to not let the whine of the charging defibrillator scare the one doing compressions off the chest (there is an understandable self-preservation instinct).  

The defibrillator will hold the charge for a little bit, but not forever (if anyone knows this #, please comment)

If its not a shockable rhythm, you don’t have to push the shock button.

 

References: study 1; study 2charge time; picture

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