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

Bo Nees Iversen; Carsten Meilandt; Ulla Væggemose; Christian Juhl Terkelsen; Hans Kirkegaard; Jesper Fjølner

doi:10.1016/j.resuscitation.2021.09.037

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

Resuscitation. 2021 Dec:169:23-30. doi: 10.1016/j.resuscitation.2021.09.037. Epub 2021 Oct 8.

Authors

Bo Nees Iversen¹, Carsten Meilandt², Ulla Væggemose³, Christian Juhl Terkelsen⁴, Hans Kirkegaard⁵, Jesper Fjølner⁶

Affiliations

¹ 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.
² 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.
³ 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.
⁴ 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.
⁵ 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.
⁶ 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. Electronic address: jespfjoe@rm.dk.

PMID: 34627866
DOI: 10.1016/j.resuscitation.2021.09.037

Abstract

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.

Keywords: Advanced life support; Cardiac arrest; Cardiopulmonary resuscitation; Defibrillation; Pre-charging; Shockable rhythm.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiography, Impedance
Cardiopulmonary Resuscitation*
Defibrillators
Electric Countershock
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest* / therapy