Guidelines

2 Minutes of CPR after Every AED Shock

It is important that rescuers of cardiac arrest victims provide 2 minutes of CPR after every shock delivered by the AED, according to guidelines provided by the International Liasion Committee on Resuscitation (ILCOR), the European Resuscitation Council (ERC) and American Heart Association (AHA).

The extracted documents with the highlighted statements (3rd page) from the ERC can be found HERE. The flow chart is as follows :

The extracted documents with the highlighted statements (2nd page) from the AHA can be found HERE.

The reasons for this is because pauses to provide shocks is detrimental to the overall outcome, provided the victim is not revived by the first shock.

According to Dr Kramer-Johansen J et al in his paper “Pauses in chest compression and inappropriate shocks: a comparison of manual and semi-automatic defibrillation attempts” published in the journal Resuscitation 2007 May;73(2):212-20, the amount of time chest compression is not done is 22 seconds (median) pre-shock and 20 seconds (median) post-shock.

What this means that in a 5 minute window period of rescue time ( starting with the first shock ) , if rescuers performs chest compression of 2 minutes in between shocks, the total time without compression is 84 seconds, compared to 168 seconds if the interval between shocks is 1 minute.

What this means is that if someone performs 1 minute of CPR in between shocks, the total time of not performing chest compressions, ie not perfusing the vital organs like the brain and the heart itself, is 2.8 minutes out of 5 minutes (56%), compared to 1.4 minute (28%) when the interval is 2 minutes of CPR in between shocks.

Local evidence that 2 minute CPR in between shocks is the right protocol is seen by the experience of one of our clients, who saved a life recently. The story can be found HERE.

However, there is clinical evidence that rescuer fatigue can set in easily, as shown below.

This is the reason why we encourage our clients to pre-plan deployment of teams to all corners of their area of coverage, and to rotate among the rescuers in providing chest compressions, if need be every minute. 5 cycles of 30:2 compressions:ventilation will last approximately 2 minutes.

Only with teamwork will we be able to achieve the best outcomes.

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Friday, July 15th, 2011 Comment No Comments