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Peri-Shock Pause

Sheldon Cheskes, MD and Zack Shinar, MD
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No me gusta!

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To clear or not to clear? That is the question. The answer, however, is still a bit nebulous for some. Zach and Sheldon continue the conversation.

 

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Rob B. -

I try to have the person performing the compressions call the shock. We confirm shockable rhythm, charge defibrillator during CPR and have the compressor say 'shock in 3, 2, 1'then immediately resume compressions with the goal of a <5sec pause in compressions. This requires a short team briefing prior to arrival of OOH cardiac arrest patient.

Michael S., -

Prehospital: We do 200 uninterrupted compressions. Charge at 180. Clear, rhythm interpretation, & shock/no shock at 200. And resume CPR with the goal being a pause of < 6 seconds.

For 2012 our Utstein Survival was at least 51.1% (and that not just prehospital ROSC but actual survival for witnessed VF arrests) with pauses that were short but still longer than the 6 second goal.

Benton H., M.D. -

Great concise points guys, kind of intimidating being on the other side from you. It sounds like we agree on a substantial amount of this stuff. I would like to briefly explain why I didn't go into the adjusted analysis from Dr. Cheskes' study, since that seemed to really annoy him. Since outcomes in the <10s group and the 10-20s group were identical, but the adjusted analysis showed a trend towards better odds of survival in the <10s group (with confidence intervals that widely overlapped 1 for the 10-20s group at 0.47-1.45), that implies that the <10s group must have been sicker to start. This is unusual in resuscitation studies, where the "aggressive" CPR is often more common in patients with the best prognosis. Unfortunately, there is no standard "Table 1" in the study, where baseline prognostic information between the groups can be compared. As a guy who focuses on methodology, this leaves no way for me to tell if the adjustments seemed to make sense - i.e. the adjusted analysis suggests that the < 10s group must have been much sicker at baseline, but I don't have any of that data in the paper to see if I agree. I have looked at papers (ECASS 3 comes to mind) where the authors adjustment seems to be counter-intuitive, so I am not willing to just believe any adjusted analysis without having at least the most important baseline prognostic information for the groups being compared given to me, so I didn't go into it (also had a time limitation).

Thanks for the work you guys are doing in helping determine how to best care for these people, mad respect.

Alexander K., M.D. -

uninterupted compressions sure make sence to me. while we still looking for a true answer, why not having something that does not conduct electricity over patients chest to protect person doing compression. all I need is a catchy name for the product and I am good to go.

Aaron A. -

I agree with the first poster--if you direct your shock carefully, the pause can be well less than 5 seconds. This splits the difference and avoids the risk.

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Episode 140 Full episode audio for MD edition 238:22 min - 100 MB - M4AResumen Mayo 2013 en español Español 80:43 min - 28 MB - MP3EM:RAP 2013 May MP3 81 MB - ZIPEM:RAP May 2013 Written Summmary 857 KB - PDFEM:RAP May 2013 Board Review Questions 635 KB - PDFEM:RAP May 2013 Board Review Questions:Answer Sheet 661 KB - PDF

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