Anticipatory charging of the defibrillator: a systematic review

To evaluate whether anticipatory charging of the defibrillator prior to rhythm analysis improves patient outcomes and resuscitation performance compared with charging the defibrillator after rhythm analysis.

We conducted a systematic review (PROSPERO CRD420251068149) through searching MEDLINE, EMBASE, and the Cochrane library from inception through November 24, 2025. Eligible studies included randomised controlled trials and observational studies comparing charging the defibrillator prior to rhythm analysis with charging after rhythm analysis. We excluded conference abstracts and unpublished literature. Risk of bias was assessed using Cochrane's Risk of Bias-2 and QUIPS, and GRADE was used for outcome assessment. Due to significant heterogeneity, meta-analysis was not performed, and a narrative synthesis of the findings is provided.

Eleven studies met inclusion criteria: five clinical observational studies and six simulation trials. Certainty of evidence was very low for all outcomes (high risk of bias and indirectness from simulation or bundled intervention studies). Observational studies showed mixed associations between anticipatory charging and survival or return of spontaneous circulation (ROSC), with some benefit when implemented in bundled interventions. Across clinical and simulation studies, anticipatory charging consistently reduced pre-shock and peri-shock pauses compared with standard charging after rhythm analysis. However, comparisons with the 2010 guideline charging method were inconsistent. Limited data from one small study of in-hospital cardiac arrests suggested similar rates of inadvertent shocks across charging strategies.

Anticipatory charging is feasible and associated with fewer interruptions in chest compressions compared with standard charging but may not be superior to the 2010 guideline charging method. Its impact on survival and neurological outcomes also remain uncertain.

PROSPERO CRD420251068149.