Longer Peri- and Preshock Pauses Linked to Poor Survival

Longer pauses tied to reduced survival for patients with cardiac arrest in a shockable rhythm

TUESDAY, June 21 (HealthDay News) -- For patients who suffer cardiac arrest and present with a shockable rhythm, longer perishock and preshock pauses are independently associated with a decrease in survival to hospital discharge, according to a study published online June 20 in Circulation.

Sheldon Cheskes, M.D., from the University of Toronto, and colleagues investigated the relationship between perishock pauses and survival to hospital discharge in 815 patients who suffered cardiac arrest between 2005 and 2007. The participants presented with a shockable rhythm of ventricular fibrillation or pulseless ventricular tachycardia, and underwent cardiopulmonary resuscitation for at least one shock. The association between survival and preshock, perishock, and postshock pauses was determined.

The investigators found that, after adjusting for Utstein predictors of survival, patients with a preshock pause of 20 seconds or more and 40 seconds or more had significantly lower odds of survival (odds ratio [OR], 0.47, and 0.54, respectively) than patients with a preshock pause of less than 10 seconds and less than 20 seconds. Postshock pause did not independently correlate with a significant change in the likelihood of survival. Survival to hospital discharge decreased by 18 percent and 14 percent, respectively, for every five-second increase in both preshock and perishock pause interval (up to 40 and 50 seconds, respectively), but it had no significant correlation with changes in the postshock pause interval.

"The impact of preshock pause on survival suggests that refinement of automatic defibrillator software and paramedic education to minimize preshock pause delays may have a significant impact on survival," the authors write.

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