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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommend stopping compressions during defibrillation, there is no convincing evidence in the literature to support this practice. This article reviews data confirming the importance of minimizing compression pauses during defibrillation of patients in cardiac arrest.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECritical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFirst Aid\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEmergency Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECritical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFirst Aid\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EJ. Scott Wieters, MD, Texas A\u0026amp;M University, Temple, Texas, USA, reviewed data confirming the importance of minimizing compression pauses during defibrillation of patients in cardiac arrest.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommend stopping compressions during defibrillation, Dr Wieters stated that there is no convincing evidence in the literature to support this practice. From 1986 to 1990, 13 injuries were reported with \u201chands-on\u201d defibrillation, most consisting of mild shocks or burns. In experimental models of hands-on defibrillation, current leakage (mean, 283 \u00b1 140 \u03bcA; range, 18.9 to 907 \u03bcA) was within the acceptable safety limits [Lloyd MS et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2008].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAt the same time, there is substantial evidence indicating that interruptions in chest compression pauses should be avoided at all costs. Cardiac perfusion drops off dramatically when chest compressions stop, and perfusion takes time to rise when compressions resume (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). In one study, if the preshock pause was \u0026gt; 10 seconds, return of spontaneous circulation (ROSC) decreased by 50% [Eftest\u00f8l T et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2002].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/46\/15.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effect of Compression Pauses on Cardiac Perfusion\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-197267679\u0022 data-figure-caption=\u0022Effect of Compression Pauses on Cardiac Perfusion\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/46\/15.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/46\/15.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/46\/15.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15526\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EEffect of Compression Pauses on Cardiac Perfusion\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from \u003Cem\u003EAmerican Journal of Emergency Medicine\u003C\/em\u003E, 30, Cunningham LM et al, Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation, 1630\u20131638. Copyright (2012), with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EIn another study, when preshock pauses were \u0026lt; 3 seconds, the ROSC was 6 times higher. Keeping postshock pauses to \u0026lt; 6 seconds led to 18 times more ROSC [Edelson DP et al. \u003Cem\u003EResuscitation\u003C\/em\u003E. 2006]. In a large multicenter trial of 815 patients with out-of-hospital (OOH) cardiac arrest, patients with a preshock pause of \u0026lt; 10 seconds had 50% less mortality when compared with patients with a preshock pause \u0026gt; 20 seconds [Cheskes S et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2011]. Every 5-second delay led to 18% mortality.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDr Wieters emphasized that compressions should certainly continue during preshock charging and that, after defibrillation, end tidal carbon dioxide should be employed in place of pulse checks to monitor perfusion.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn a prospective observational cohort study of 506 cases of OOH cardiac arrest, the best survival (28.7%) was seen when the compressions were performed 60% to 80% of the total resuscitation time [Christensen J et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2009]. Physicians should therefore aim for a chest compression fraction \u0026gt; 80%. Dr Wieters concluded by stating that a shock delivered with perfusion pressure at its peak will more likely result in ROSC.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/46\/15.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzohg1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzohg1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}