Effect of timing and duration of a single chest compression pause on short-term survival following prolonged ventricular fibrillation.

Authors:	Gregory P Walcott, Sharon B Melnick, Robert G Walker, Isabelle Banville, Fred W Chapman, Cheryl R Killingsworth, Raymond E Ideker
Language:	Eng.
Date:	2009-03-09
Journal:	Resuscitation (0300-9572)
Release:	Resuscitation. 2009 Apr;80(4):458-62
Abstract:	BACKGROUND: Pauses during chest compressions are thought to have a detrimental effect on resuscitation outcome. The Guidelines 2005 have recently eliminated the post-defibrillation pause. Previous animal studies have shown that multiple pauses of increasing duration decrease resuscitation success. We investigated the effect of varying the characteristics of a single pause near defibrillation on resuscitation outcome. METHODS: Part A: 48 swine were anesthetized, fibrillated for 7min and randomized. Chest compressions were initiated for 90s followed by defibrillation and then resumption of chest compressions. Four groups were studied-G2000: 40s pause beginning 20s before, and ending 20s after defibrillation, A1: a 20s pause just before defibrillation, A2: a 20s pause ending 30s prior to defibrillation, and group A3: a 10s pause ending 30s prior to defibrillation. Part B: 12 swine (Group B) were studied with a protocol identical to Part A but with no pause in chest compressions. Primary endpoint was survival to 4h. RESULTS: The survival rate was significantly higher for groups A1, A2, A3, and B (5/12, 7/12, 5/12, and 5/12 survived) than for the G2000 group (0/12, p<0.05). Survival did not differ significantly among groups A1, A2, A3, and B. CONCLUSIONS: These results suggest that the Guidelines 2005 recommendation to omit the post-shock pulse check and immediately resume chest compressions may be an important resuscitation protocol change. However, these results also suggest that clinical maneuvers further altering a single pre-shock chest compression pause provide no additional benefit.
Copyright:	Resuscitation University of Alabama, B140 Volker Hall, 1670 University Blvd., Birmingham, AL 35294, United States. gpw crml.uab.edu
Full text:	DOI - Resuscitation (DOI) EBSCO - HTML (needs subscription) Elsevier Science - HTML (needs subscription) OhioLINK Electronic Journal Center - HTML (needs subscription) Swets Information Services - HTML (needs subscription)
Terms:	Animals, Blood Pressure, Disease Models, Animal, Electric Countershock, Female, Heart Arrest, Heart Massage, Heart Rate, Male, Periodicity, Swine, Time Factors, Ventricular Fibrillation