From the Guidelines
During in-hospital cardiac arrest, total preshock and postshock pauses in chest compressions should be as short as possible, with the healthcare provider minimizing the time taken to check for a pulse to no more than 10 seconds. When considering the frequency of pauses, it's crucial to prioritize minimizing interruptions to chest compressions, as each pause can significantly impact the effectiveness of the resuscitation efforts 1. The guidelines suggest that when 2 or more rescuers are available, switching chest compressors approximately every 2 minutes can help prevent decreases in the quality of compressions 1. Key points to consider include:
- Minimizing total preshock and postshock pauses in chest compressions 1
- Limiting pulse checks to no more than 10 seconds 1
- Switching chest compressors every 2 minutes when multiple rescuers are available 1
- Immediately resuming chest compressions after shock delivery 1
- Pausing compressions to deliver 2 breaths, each given over 1 second, for adults in cardiac arrest receiving CPR without an advanced airway 1
- Aiming for a chest compression fraction of at least 60% 1. By following these guidelines and minimizing pauses, healthcare providers can maximize the effectiveness of cardiopulmonary resuscitation and improve patient outcomes.
From the Research
Frequency of Pauses During In-Hospital Cardiac Arrest
- The frequency of pauses during in-hospital cardiac arrest is a critical aspect of cardiopulmonary resuscitation (CPR) that can impact clinical outcomes 2.
- A study analyzing video data from simulated pediatric cardiac arrest scenarios found that pauses in chest compressions occurred frequently, with a median of 10 pauses per scenario (interquartile range, 7-12) 2.
- The median pause duration was 5 seconds (interquartile range, 2-9 s), with 91% chest compression fraction per scenario (interquartile range, 88-94%) 2.
- The most common tasks associated with pauses were a change of chest compressors (25%), performing pulse check (24%), and performing rhythm check (15%) 2.
Factors Associated with Pause Duration
- Pauses lasting greater than 10 seconds were associated with shock delivery, performing rhythm check, and performing pulse check (p < 0.001) 2.
- A high shared mental model among the resuscitation team was associated with significantly shorter pause durations (mean difference, 4.2 s; 95% CI, 1.6-6.8 s; p = 0.002) 2.
Limitations of Current Evidence
- The available studies do not provide direct evidence on the frequency of pauses during in-hospital cardiac arrest in adult populations 2, 3, 4, 5, 6.
- Further research is needed to determine the frequency and duration of pauses during in-hospital cardiac arrest and to identify strategies to minimize pause frequency and duration.