Assessment of chest compression interruptions during advanced cardiac life support

To identify potentially avoidable factors responsible for chest compression interruptions and to evaluate the influence of chest compression fraction on achieving return of spontaneous circulation and survival to hospital discharge.

In this prospective observational study, each resuscitation managed by mobile medical teams from August 1st, 2016, to August 1st, 2018 was video recorded using a body-mounted GoPro camera. The duration of all chest compression interruptions was recorded and chest compression fraction was calculated. All actions causing an interruption of at least 10 s were analyzed.

Two hundred and six resuscitations of both in- and out-of-hospital cardiac arrest patients were analysed. In total 1867 chest compression interruptions were identified. Of these, 623 were longer than 10 s in which a total of 794 actions were performed. In 4.3% of the registered pauses, cardiopulmonary resuscitation was interrupted for more than 60 s. The most performed actions during prolonged interruptions were rhythm/pulse checks (51.6%), installation/use of mechanical chest compression devices (11.1%), cardiopulmonary resuscitation provider switches (6.7%) and ETT placements (6.2%). No statistically significant relationship was found between chest compression fraction and return of spontaneous circulation or survival.

The majority of chest compression interruptions during resuscitation were caused by prolonged rhythm checks, cardiopulmonary resuscitation provider switches, incorrect use of mechanical chest compression devices and ETT placement. No association was found between chest compression fraction and return of spontaneous circulation, nor an influence on survival. This was presumably caused by the high baseline chest compression fraction of >86%.