Don't Stop Compressin'!

Summary and Comment |
August 14, 2015

Don't Stop Compressin'!

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Longer pauses in chest compressions were associated with lower survival in patients with ventricular fibrillation cardiac arrest.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Current cardiopulmonary resuscitation (CPR) guidelines emphasize continuous compressions with minimal interruptions. The focus has been on minimizing perishock pauses, as these were the types of pauses most easily measured during ongoing resuscitations. However, impedance recording capabilities of newer defibrillators allow measurement of all interruptions. To determine whether pauses for any reason are associated with reduced survival, researchers reviewed all cases of ventricular fibrillation out-of-hospital cardiac arrest in Amsterdam in 2009 for which all continuous impedance recordings were available (including from public access defibrillators).

A total of 319 patients were included, with an overall survival to hospital discharge of 38%. A multivariate regression model demonstrated decreased odds of survival for each 5-second increase in the longest chest compression pause (odds ratio, 0.89). The longest pause was for reasons other than shock delivery in 36% of patients; survival was lower in these patients than in those whose longest pause was associated with defibrillation (27% vs. 44%).

Comment

CPR shouldn't be paused for anything except defibrillation, and even those pauses should be very brief. Nonshock pauses (e.g., for intubation) are clearly associated with worse patient outcomes, and we should aim to minimize or eliminate them from our patients' resuscitations.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Speaker's bureau Airway Management Education Center Leadership positions in professional societies Society for Academic Emergency Medicine (Constitution and Bylaws Committee Chair, Program Committee Chair, and Trauma Interest Group Chair); American College of Emergency Physicians (Trauma and Injury Prevention Section Chair)

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