Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm,Resuscitation

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Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm
Resuscitation ( IF 6.5 ) Pub Date : 2021-10-08 , DOI: 10.1016/j.resuscitation.2021.09.037
Bo Nees Iversen ₁ , Carsten Meilandt ₂ , Ulla Væggemose ₃ , Christian Juhl Terkelsen ₄ , Hans Kirkegaard ₅ , Jesper Fjølner ₆

Affiliation

Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Anaesthesia and Operation 1, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark.
Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3. Floor, 1120 Copenhagen K, Denmark.
Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Research Centre for Emergency Medicine, Emergency Department, Palle Juul-Jensens Boulevard 99 Aarhus University Hospital, Aarhus, Denmark.
Prehospital Emergency Medical Services, Central Denmark Region, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Research and Development, Prehospital Emergency Medical Services, Oluf Palmes Allé 34, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.

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.

中文翻译：

在心律分析之前对除颤器进行预充电可减少具有可电击心律的院外心脏骤停患者的放手时间

目标

评估在心律分析前对除颤器进行预充电对院外心脏骤停伴可电击心律患者放手时间的影响。

方法

预充电于 2018 年 6 月在丹麦中部地区的紧急医疗服务中实施。培训包括动手模拟场景、电子学习材料和书面说明。数据是从丹麦心脏骤停登记处提取的，为期 14 个月，跨越了预充电的实施。包括接受过至少一次电击的患者。分析了经胸阻抗数据。我们记录了所有除颤程序的放手时间和电击期间的停顿，以及所有心脏骤停的总放手分数。

结果

可获得 178 名患者的阻抗和结果数据。分析了 523 个除颤程序。预充电方法与每个除颤程序的中位放手时间较短（7.6 (IQR 5.8–9.9) 比 12.6 (IQR 10–16.4) 秒，p < 0.001）有关，但电击前暂停时间更长（4 (IQR 5.8–9.9) 2.7–6.1) 与 1.7 (IQR 1.2–3) 秒，p < 0.001) 与当前指南推荐的除颤方法相比。实施预充电方法后，每次心脏骤停的总不干预分数降低（16.5% 对 20.4%，p = 0.003）。对不可电击节律或人员的电击没有增加。仅接受预充电除颤的患者自主循环恢复的优势比增加（aOR 2.91；95%CI 1.09–7.8，p = 0.03）。