Chest compression pauses during defibrillation attempts.

PURPOSE OF REVIEW: This article summarizes current knowledge of the causes and consequences of interruption of chest compressions during cardiopulmonary resuscitation.

RECENT FINDINGS: Pauses in chest compressions occur during analysis of the heart rhythm, delivery of ventilation, interventions such as intubation, and gaining intravenous access, but pauses may also be unprompted. Pauses related to defibrillation are because of preshock pauses for rhythm analysis and charging, and postshock pauses to evaluate the outcome of the shock. Prolonged pauses, mainly preshock pauses (>10 s) are associated with decreased survival to discharge in retrospective analyses. Measures to reduce preshock and postshock pauses include resuming chest compressions during defibrillator charging, continued chest compression during defibrillation by mechanical chest compression devices or during manual chest compression with sufficiently insulating gloves for the rescuer, and eliminating postshock rhythm and pulse checks. New filtering techniques may allow rhythm analysis during chest compressions.

SUMMARY: It is important to avoid any unnecessary pause in chest compressions before and after a defibrillation shock. Pauses should be kept to an absolute minimum, preferably to less than 10 s.