Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

Ting Yu, MD; Max Harry Weil, MD, PhD; Wanchun Tang, MD; Shijie Sun, MD; Kada Klouche, MD; Heitor Povoas, MD; Joe Bisera, MSEE

From The Institute of Critical Care Medicine, Palm Springs (T.Y., M.H.W., W.T., S.S., K.K., H.P., J.B.), and the Keck School of Medicine of the University of Southern California, Los Angeles (M.H.W., W.T., S.S., J.B.), Calif.

Correspondence to Max Harry Weil, MD, PhD, The Institute of Critical Care Medicine, 1695 N Sunrise Way, Building 3, Palm Springs, CA 92262-5309. E-mail weilm@911research.org

Background— Current versions of automated external defibrillators (AEDs) require frequent stopping of chest compression for rhythm analyses and capacity charging. The present study was undertaken to evaluate the effects of these interruptions during the operation of AEDs.

Methods and Results— Ventricular fibrillation was electrically induced in 20 male domestic swine weighing between 37.5 and 43 kg that were untreated for 7 minutes before CPR was started. Defibrillation was attempted with up to 3 sequential 150-J biphasic shocks, but each was preceded by 3-, 10-, 15-, or 20-second interruptions of chest compression. The interruptions corresponded to those that were mandated by commercially marketed AEDs for rhythm analyses and capacitor charge. The sequence of up to 3 electrical shocks and delays were repeated at 1-minute intervals until the animals were successfully resuscitated or for a total of 15 minutes. Spontaneous circulation was restored in each of 5 animals in which precordial compression was delayed for 3 seconds before the delivery of the first and subsequent shocks but in none of the animals in which the delay was >15 seconds before the delivery of the first and subsequent shocks. Longer intervals of CPR interventions were required, and there was correspondingly greater failure of resuscitation in close relationship to increasing delays. The durations of interruptions were inversely related to the durations of subthreshold levels of coronary perfusion pressure. Postresuscitation arterial pressure and left ventricular ejection fraction were more severely impaired with increasing delays.

Conclusions— Interruptions of precordial compression for rhythm analyses that exceed 15 seconds before each shock compromise the outcome of CPR and increase the severity of postresuscitation myocardial dysfunction.

Key Words: cardiopulmonary resuscitation • fibrillation • defibrillation • compression • myocardium