Section of Hospital Medicine and Emergency Resuscitation Center, University of Chicago, Chicago, IL, USA.
Resuscitation. 2010 Nov;81(11):1521-6. doi: 10.1016/j.resuscitation.2010.07.014.
Pauses in chest compressions during cardiopulmonary resuscitation have been shown to correlate with poor outcomes. In an attempt to minimize these pauses, the American Heart Association recommends charging the defibrillator during chest compressions. While simulation work suggests decreased pause times using this technique, little is known about its use in clinical practice.
We conducted a multi-center, retrospective study of defibrillator charging at three US academic teaching hospitals between April 2006 and April 2009. Data were abstracted from CPR-sensing defibrillator transcripts. Pre-shock pauses and total hands-off time preceding the defibrillation attempts were compared among techniques.
A total of 680 charge-cycles from 244 cardiac arrests were analyzed. The defibrillator was charged during ongoing chest compressions in 448 (65.9%) instances with wide variability across the three sites. Charging during compressions correlated with a decrease in median pre-shock pause [2.6s (IQR 1.9-3.8) vs 13.3s (IQR 8.6-19.5); p < 0.001] and total hands-off time in the 30s preceding defibrillation [10.3s (IQR 6.4-13.8) vs 14.8s (IQR 11.0-19.6); p < 0.001]. The improvement in hands-off time was most pronounced when rescuers charged the defibrillator in anticipation of the pause, prior to any rhythm analysis. There was no difference in inappropriate shocks when charging during chest compressions (20.0% vs 20.1%; p = 0.97) and there was only one instance noted of inadvertent shock administration during compressions, which went unnoticed by the compressor.
Charging during compressions is underutilized in clinical practice. The technique is associated with decreased hands-off time preceding defibrillation, with minimal risk to patients or rescuers.
心肺复苏期间的胸外按压暂停与不良预后相关。为尽量减少这些暂停，美国心脏协会建议在进行胸外按压时对除颤器进行充电。虽然模拟研究表明，使用该技术可以减少暂停时间，但对其在临床实践中的应用知之甚少。
我们对 2006 年 4 月至 2009 年 4 月期间美国三家学术教学医院的除颤器充电进行了一项多中心、回顾性研究。从 CPR 感应除颤器记录中提取数据。比较了不同技术在除颤前的预电击暂停时间和总脱手时间。
共分析了 244 例心搏骤停的 680 个充电周期。在 448 个（65.9%）情况下，除颤器在持续进行的胸外按压期间进行充电，三个地点之间的差异很大。在按压过程中充电与中位数预电击暂停时间[2.6s（IQR 1.9-3.8）vs 13.3s（IQR 8.6-19.5）；p < 0.001]和除颤前 30 秒内总脱手时间[10.3s（IQR 6.4-13.8）vs 14.8s（IQR 11.0-19.6）；p < 0.001]的减少相关。当救援人员在进行任何节律分析之前，预期暂停并对除颤器进行充电时，脱手时间的改善最为明显。在按压过程中充电时，不当电击的发生率没有差异（20.0% vs 20.1%；p = 0.97），仅记录到一例在按压过程中意外电击，而按压者未注意到。
在临床实践中，按压时充电的使用率较低。该技术与除颤前脱手时间减少相关，对患者或救援人员的风险最小。
