Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Rhythm check timing

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest in any setting (P), does checking the cardiac rhythm immediately after defibrillation (I), compared with immediate resumption of chest compressions with delayed check of the cardiac rhythm (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, recurrence of VF (O)?
Consensus on Science:
For the critical outcome of survival with favorable neurologic outcome at discharge, we identified very-low-quality evidence (downgraded for serious risk of bias, indirectness, and imprecision) from 3 observational studies enrolling 763 OHCAs showing a harmful effect for interrupting chest compressions to check rhythm immediately after shock delivery (RR, 0.62; 95% CI, 0.51–0.75).(Kellum 2006, 335; Rea 2006, 2760; Bobrow 2008, 1158) For the critical outcome of survival hospital discharge, we identified low-quality evidence from 1 RCT enrolling 845 OHCAs showing no benefit for interrupting chest compressions to check rhythm immediately after shock delivery (RR, 0.80; 95% CI, 0.55–1.15)(Jost 2010, 1614) and very-low-quality evidence (downgraded for serious risk of bias and indirectness) from 3 observational studies enrolling 3094 OHCAs showing a harm effect for checking rhythm immediately after defibrillation (RR, 0.55; 95% CI, 0.45–0.67).(Kellum 2006, 335; Rea 2006, 2760; Bobrow 2008, 1158) In addition, for the same outcome, we identified very-low-quality evidence from 1 observational study of 528 victims of OHCA showing potential harm for interrupting chest compressions to check rhythm immediately after shock delivery (RR, 0.42; 95% CI, 0.29–0.61).(Bobrow 2008, 1158) For the critical outcome of survival to hospital admission, we identified low-quality evidence from 1 RCT enrolling 845 victims of OHCA showing no benefit for interrupting chest compressions to check rhythm immediately after shock delivery (RR, 0.99; 95% CI, 0.85–1.15).(Jost 2010, 1614) For the critical outcome of ROSC, we identified very-low-quality evidence (downgraded for serious risk of bias and indirectness) from 2 observational studies enrolling 2969 victims of OHCA showing a harm effect for interrupting chest compressions to check rhythm immediately after shock delivery (RR, 0.69; 95% CI, 0.61–0.78).(Rea 2006, 2760; Bobrow 2008, 1158) For the important outcome of recurrence of VF, we identified low-quality evidence from 1 RCT, enrolling 136 OHCAs showing no benefit for interrupting chest compressions to check rhythm immediately after shock delivery (RR, 1.00; 95% CI, 0.81–1.23).(Berdowski 2010, 72)
Treatment Recommendation:
We suggest immediate resumption of chest compressions after shock delivery for adults in cardiac arrest in any setting (weak recommendation, very-low-quality evidence). If there is alternative physiologic evidence of ROSC (eg, arterial waveform or rapid rise in ETCO2), chest compressions can be paused briefly for rhythm analysis. Values, Preferences, and Task Force Insights In making this recommendation, we place a higher value on avoiding interruptions in chest compressions for an intervention showing no benefit for critical and important outcomes. Also, this recommendation assumes that shocks are generally effective and that a perfusing rhythm is generally not present immediately after elimination of VF.
CoSTR Attachments:
Evidence Table (GRADE) _G Ristagno_n.docx    
GRADE GRID (recommendations) _G Ristagno_n.docx    
ILCOR Data Collection Form Template _G Ristagno_n.xls    
Summary of Bias Assessments _G Ristagno_n.xlsx    

 Contact Us

 
If you have any comments or questions on this page, please email us at: