Hold your ground during the charge!

#AAEM15 Winters: 18% Inc in mortality per 5 seconds of pause during CPR. http://t.co/QpVVdvYx7F
— San Antonio EM (@SanAntonioEM) March 2, 2015

Excuse me? you said what?

"In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses." (Cheskes et all., 2013)

Decreasing peri-shock pauses is a good thing. 

Fig. 2. Cheskes et all., 2013

The less time we are squeezing the chest, the less time the victim is perfusing and the less their chances of survival. To maximize perfusion, the 2010 AHA Guidelines for CPR and ECC recommend minimizing pauses in chest compressions. Expert consensus is that a Chest Compression Fraction (CCF) of 80% is achievable in a variety of settings. (Meaney et all., 2013) A viable method to decrease compression pauses is to perform compressions as shocks are charged and delivered*. The purpose of CPR is to compensate for the failure of the heart to adequately pump blood throughout the body. We're trying to perfuse the heart (and brain) well enough to get the heart excitable (Ventricular fibrillation/Tachycardia) and restartable (Shock/defibrillation). 

From RebelEM

*While some evidence suggest CPR during defibrillation is safe and has benefit (Neumann et all., 2012)  the AHA does NOT recommend it. Rescuer safety is the highest priority in any scenario and should stay that way!

However, as technology evolves and research continues we may find a way to safely keep hands on during the entire incident. With the increasing frequency of CPR quality monitoring devices (or CPR pucks as I've called them so far) we may have a viable barrier to protect providers from electrical shocks, with the risk of redirecting high voltage electricity into monitors worth thousands of dollars.

Until that day, remember an 80% CCF and rate of 100-120. feel free to use this excellent reference material for a rate.

Bibliography:

Cheskes, S., Schmicker, R. H., Verbeek, P. R., Salcido, D. D., Brown, S. P., Brooks, S., … Christenson, J. (2014). The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation, 85(3), 336–42. doi:10.1016/j.resuscitation.2013.10.014

Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., … Leary, M. (2013). Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation, 128(4), 417–35. doi:10.1161/CIR.0b013e31829d8654

Neumann, T., Gruenewald, M., Lauenstein, C., Drews, T., Iden, T., & Meybohm, P. (2012). Hands-on defibrillation has the potential to improve the quality of cardiopulmonary resuscitation and is safe for rescuers-a preclinical study. Journal of the American Heart Association, 1(5), e001313. doi:10.1161/JAHA.112.001313