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. 2008 Jul;78(1):71-6.
doi: 10.1016/j.resuscitation.2008.02.014. Epub 2008 May 14.

Immediate post-shock chest compressions improve outcome from prolonged ventricular fibrillation

Robert A Berg  1 , Ronald W Hilwig, Marc D Berg, David D Berg, Ricardo A Samson, Julia H Indik, Karl B Kern
Affiliations

Immediate post-shock chest compressions improve outcome from prolonged ventricular fibrillation

Robert A Berg et al. Resuscitation. 2008 Jul.

Abstract

Aim: This study was designed to test the hypothesis that immediate post-shock chest compressions improve outcome from prolonged ventricular fibrillation (VF) compared with typical "hands off" period (i.e., delayed post-shock compressions) associated with AED use.

Materials and methods: After 7.5 min of untreated VF, 36 domestic swine (26+/-1 kg) were treated with 200 J biphasic shocks and randomly assigned to: (1) 1 min of immediate post-shock chest compressions or (2) simulated pre-hospital automated external defibrillator (AED) care with delays in post-shock chest compressions. Return of spontaneous circulation (ROSC) occurred in 7/18 immediate chest compressions animals within 2 min of the first shock versus 0/18 AED animals (P<0.01). Ten of 18 immediate chest compressions animals attained ROSC compared with 3/18 AED animals (P<0.05). Nine of 18 immediate chest compressions swine were alive at 24 and 48 h compared with 3/18 AED swine (P<0.05). All 48-h survivors had good neurologic outcomes. Among the 21 animals that defibrillated with the first shock, ROSC was attained in 7/10 immediate chest compressions animals within 2 min of the first shock compared with 0/11 AED animals (P=0.001), and 48-h survival was attained in 8/10 versus 3/11, respectively (P<0.05).

Conclusions: Immediate post-shock chest compressions can substantially improve outcome from prolonged VF compared with simulated pre-hospital AED care.

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Conflict of interest statement

Conflict of interest

The authors have no other potential conflicts in regard to this study.

Figures

Figure 1
Figure 1
Graphic representation of the experimental time-line. After 7.5 min of untreated VF, animals were randomized in the BLS (basic life support) period to: (1) 1 min of immediate post-shock continuous chest compressions without rescue breaths or (2) simulated AED care with no compressions for 55 s, followed by delayed post-shock chest compressions and rescue breathing with a compression:ventilation ratio of 15:2. Animals that attained ROSC (return of spontaneous circulation) were provided with ICU (intensive care unit) care (i.e., mechanical ventilation and anesthesia).
Figure 2
Figure 2
Graphic representation of outcomes of the animals in the two experimental groups after 7.5 min of VF (ventricular fibrillation), including electrocardiographic response to the first and second shocks, as well as the resuscitation outcomes among animals defibrillated with the first two shocks (Defib with 1 to 2 shocks) and those not defibrillated after 2 shocks (VF after 2 shocks). AED refers to automated external defibrillator; CC, chest compressions; PEA, pulseless electrical activity; NSR, normal sinus rhythm; ROSC, return of spontaneous circulation.
See this image and copyright information in PMC

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