European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: Automated external defibrillators, defibrillation, cardioversion and pacing
Section snippets
Summary of changes since 2005 Guidelines
The most important changes in the 2010 European Resuscitation Council (ERC) guidelines for electrical therapies include:
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The importance of early, uninterrupted chest compressions is emphasised throughout these guidelines.
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Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses. The continuation of compressions during charging of the defibrillator is recommended.
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Immediate resumption of chest compressions following defibrillation is also emphasised; in combination
A vital link in the Chain of Survival
Defibrillation is a key link in the Chain of Survival and is one of the few interventions that have been shown to improve outcome from VF/VT cardiac arrest. The previous guidelines published in 2005 rightly emphasized the importance of early defibrillation with minimum delay.1, 2
The probability of successful defibrillation and subsequent survival to hospital discharge declines rapidly with time3, 4 and the ability to deliver early defibrillation is one of the most important factors in
Automated external defibrillators
Automated external defibrillators are sophisticated, reliable computerised devices that use voice and visual prompts to guide lay rescuers and healthcare professionals to safely attempt defibrillation in cardiac arrest victims. Some AEDs combine guidance for defibrillation with guidance for the delivery of optimal chest compressions. Use of AEDs by lay or non-healthcare rescuers is covered in Section 2.19
In many situations, an AED is used to provide initial defibrillation but is subsequently
Minimising the pre-shock pause
The delay between stopping chest compressions and delivery of the shock (the pre-shock pause) must be kept to an absolute minimum; even 5–10 s delay will reduce the chances of the shock being successful.31, 32, 42 The pre-shock pause can easily be reduced to less than 5 s by continuing compressions during charging of the defibrillator and by having an efficient team coordinated by a leader who communicates effectively. The safety check to ensure that nobody is in contact with the patient at the
One-shock versus three-stacked shock sequence
A major change in the 2005 guidelines was the recommendation to give single rather than three-stacked shocks. This was because animal studies had shown that relatively short interruptions in external chest compression to deliver rescue breaths114, 115 or perform rhythm analysis33 were associated with post-resuscitation myocardial dysfunction and reduced survival. Interruptions in external chest compression also reduced the chances of converting VF to another rhythm.32 Analysis of CPR
Defibrillation of children
Cardiac arrest is less common in children. Common causes of VF in children include trauma, congenital heart disease, long QT interval, drug overdose and hypothermia.164, 165, 166 Ventricular fibrillation is relatively rare compared with adult cardiac arrest, occurring in 7-15% of paediatric and adolescent arrests.166, 167, 168, 169, 170, 171 Rapid defibrillation of these patients may improve outcome.171, 172
The optimal energy level, waveform and shock sequence is unknown but as with adults,
Cardioversion
If electrical cardioversion is used to convert atrial or ventricular tachyarrhythmias, the shock must be synchronised to occur with the R wave of the electrocardiogram rather than with the T wave: VF can be induced if a shock is delivered during the relative refractory portion of the cardiac cycle.183 Synchronisation can be difficult in VT because of the wide-complex and variable forms of ventricular arrhythmia. Inspect the synchronisation marker carefully for consistent recognition of the R
Pacing
Consider pacing in patients with symptomatic bradycardia refractory to anti-cholinergic drugs or other second line therapy (see Section 4).113 Immediate pacing is indicated especially when the block is at or below the His-Purkinje level. If transthoracic pacing is ineffective, consider transvenous pacing. Whenever a diagnosis of asystole is made, check the ECG carefully for the presence of P waves because this will likely respond to cardiac pacing. The use of epicardial wires to pace the
Implantable cardioverter defibrillators
Implantable cardioverter defibrillators (ICDs) are becoming increasingly common as the devices are implanted more frequently as the population ages. They are implanted because a patient is considered to be at risk from, or has had, a life-threatening shockable arrhythmia and are usually embedded under the pectoral muscle below the left clavicle (in a similar position to pacemakers, from which they cannot be immediately distinguished). On sensing a shockable rhythm, an ICD will discharge
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Cited by (118)
Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden – A population-based register study of more than 18,000 cases
2018, International Journal of CardiologyAutomated identification of shockable and non-shockable life-threatening ventricular arrhythmias using convolutional neural network
2018, Future Generation Computer SystemsCitation Excerpt :Generally, AEDs are furnished with an algorithm to assess the ECG signals. A shock can only be applied to the patient if the algorithm detects a shockable ECG signal [16]. Therefore, there is a need to develop a tool for an automated detection system to accurately identify shockable and non-shockable ECG signals at an instance.
Update on in hospital resuscitation
2016, Medicina Clinica