Abstract 1805: Audio Analysis of Pauses during CPR Delivered by Hospital Responders

Background: Recent investigations have suggested that pauses during chest compression delivery are common and longer than expected, and that they may have serious consequences for hemodynamics during CPR. There are no published data characterizing the etiology and duration of these pauses during actual resuscitation attempts. Objectives: To characterize the nature and duration of pauses in chest compressions as administered by health care providers and test the hypothesis that pauses for pulse checks are longer than for other pause etiologies. Methods: A prospective, observational study was conducted using a commercially available monitor/defibrillator with CPR and audio recording capabilities (MRx-QCPR, Phillips Medical Systems) during in-hospital cardiac arrests at a tertiary care medical center from 4/2006 until 8/2006. The audio recordings from each pause in chest compressions were transcribed. Etiology of the pause was determined by three independent investigators, blinded to the duration of the pause. Results: Audio recordings from 109 total pauses were analyzed from 12 consecutive arrests containing discernable audio transcripts with a mean pause time of 13.8±9.3 seconds and an average of 9±6 pauses recorded per arrest. Pulse checks were noted in 44% of the pauses, which had significantly longer pause times than pauses not attributable to pulse checks (16.1±10.4 vs. 12.1±7.8 sec. sec; p=0.03). Other pause etiologies included those surrounding defibrillation (mean pause duration: 14.3±11.8 sec; n=15), as well as those for intubation, rescuer rotation, and central line placement. Conclusions: Pauses in CPR occur for a variety of reasons besides pulse checks, and have hemodynamically relevant durations. Our results demonstrate that pauses for pulse checks are longer than pauses for other reasons. Human performance issues during CPR (such as difficulties with pulse evaluation) may play a large role in resuscitation quality, underscoring the need for objective monitoring and reporting of CPR delivery.