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Do pulse checks delay semiautomatic defibrillation by EMT-defibrillators?
J E Gough1, A R Cotten, L H Brown
1Department of Emergency Medicine, University Medical Center of Eastern Carolina, Pitt County, Greenville, North Carolina, USA.
Insights
Pulse checks by emergency medical technicians (EMTs) delay defibrillation for cardiac arrest patients. While statistically significant, the 2.7-second delay may not be clinically relevant, suggesting pulse checks could be reconsidered.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Practice Guidelines
Background:
- Current Advanced Cardiac Life Support (ACLS) guidelines from the American Heart Association (AHA) omit pulse checks between initial defibrillations for pulseless ventricular tachycardia/fibrillation.
- The AHA posits that pulse checks unnecessarily delay critical defibrillation.
- This study investigates the impact of pulse checks on defibrillation timing by EMT-Defibrillators (EMT-Ds).
Purpose of the Study:
- To quantify the time delay introduced by pulse checks performed by EMT-Ds between successive defibrillations.
- To evaluate the clinical significance of any observed delay in the context of emergency cardiac care.
Main Methods:
- Twenty-seven EMT-Ds participated in a study using a semiautomatic external defibrillator (SAED).
- Two test scenarios were employed: one with pulse checks after the first and second defibrillations, and one without.
- The time interval between the first and third defibrillation was meticulously recorded.
Main Results:
- The mean time to deliver three defibrillations was 60.2 ± 6.2 seconds with pulse checks.
- Without pulse checks, the mean time was 57.5 ± 4.6 seconds.
- A statistically significant delay of 2.7 ± 5.9 seconds was observed when pulse checks were performed (P = 0.026).
Conclusions:
- Pulse checks by EMT-Ds demonstrably delay the administration of defibrillation.
- Despite statistical significance, the clinical impact of this 2.7-second delay warrants consideration.
- Reinstatement of pulse checks within AHA guidelines may be warranted, pending further clinical significance evaluation.
Abstract:
Advanced cardiac life support (ACLS) guidelines from the American Heart Association (AHA) now recommend not checking for a pulse between the initial three defibrillations for pulseless patients in ventricular tachycardia or fibrillation. The AHA asserts that checking for a pulse needlessly delays defibrillation. This study was undertaken to determine if pulse checks delay defibrillation by EMT-Defibrillators (EMT-Ds) using a semiautomatic defibrillator (SAED). Twenty-seven EMT-Ds demonstrated delivery of three successive defibrillations during two test scenarios: once with and once without pulse checks after the first and second defibrillations. The time from the first to third defibrillation was recorded. The mean time to deliver the defibrillations was 60.2 +/- 6.2 seconds with pulse checks and 57.5 +/- 4.6 seconds without pulse checks. The difference, 2.7 +/- 5.9 seconds, was statistically significant (P = 0.026). Pulse checks by EMT-Ds do delay administration of defibrillations, but consideration should be given to reinstating pulse checks as a part of the AHA guidelines, since this delay is of questionable clinical significance.