Some resuscitation services advocate or teach routine manual defibrillator charging prior to a rhythm check during cardiopulmonary resuscitation. We aimed to review the evidence for anticipatory defibrillator charging compared with charging after a shockable rhythm is confirmed. This scoping review was performed according to a specific methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Grey literature was also reviewed using similar methodology and included in the results. There are no randomized clinical trials studying anticipatory manual defibrillator charging. The limited available data does not address critical or important patient outcomes such as defibrillation success, return of spontaneous circulation, survival to hospital discharge or neurological outcomes. Evidence primarily from manikin studies and the grey literature suggests that anticipatory charging is feasible, safe, and can reduce the total pause duration during the period of chest compression between rhythm checks, but can increase the pre-shock pause and total peri-shock pause duration. Anticipatory manual defibrillator charging appears to be feasible in the clinical setting, although its impact on clinical outcomes is uncertain. Future studies of anticipatory charging should focus on clinical outcomes.
The National Service Framework for Coronary Heart Disease requires identification of patients with an acute coronary syndrome (ACS) to enable prompt identification of those who may subsequently require pre-hospital thrombolysis. The Advanced Medical Priority Dispatch System (AMPDS) with Department of Health (DH) call prioritisation is now the common triage tool for emergency ('999') calls in the UK. We retrospectively examined patients with ACS to identify whether this triage tool had been able to allocate an appropriate emergency response.All emergency calls to Hampshire Ambulance Service NHS Trust (HAST) from the Southampton area over an 8 month period (January to August 2004) were analysed. The classification allocated to the patient by AMPDS (version 10.4) was specifically identified. Data from the Myocardial Infarct National Audit Project) were obtained from the receiving hospital in Southampton to identify the actual number of patients with a true ACS.In total, 42 657 emergency calls were made to HAST from the Southampton area. Of these, 263 patients were subsequently diagnosed in hospital as having an ACS. Of these 263 patients, 76 presented without chest pain. Sensitivity of AMPDS for detecting ACS in this sample was 71.1% and specificity 92.5%. Positive predictive value was 5.6% (95% confidence interval 4.8 to 6.4%), and 12.5% (33/263) of patients with confirmed ACS were classified as non-life threatening (category B) incidents.Only one of approximately every 18 patients with chest pain has an ACS. AMPDS with DH call prioritisation is not a tool designed for clinical diagnosis, and its extension into this field does not enable accurate identification of patients with ACS.
Diese Darstellung legt die Leitlinien zur Defibrillation mit so genannten automatisierten externen Defibrillatoren (AED) und mit manuellen Defibrillatoren dar. Medizinisches Personal und auch Laienhelfer sind in der Lage, AEDs als einen integralen Bestandteil der Basisreanimation anzuwenden. Im Rahmen der erweiterten Wiederbelebung ist die manuelle Defibrillation Teil der Behandlung. Da bei vielen Defibrillatoren die synchronisierte Kardioversion und die Schrittmachertherapie (Pacing) zu den Grundfunktionen gehören, wird beides ebenfalls in diesem Kapitel abgehandelt.
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