Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Cardiac arrest is a major health concern that has been linked to poor disease outcomes. Cardiopulmonary resuscitation (CPR) is a critical protocol for restoring spontaneous circulation. The guidelines used by medical staff differ across different countries. A comparison of these guidelines can help in designing more efficient Advanced Life Support (ALS) protocols. The goal in this study was to compare the guidelines for interruption of compression during CPR (hands-off time) for ALS protocols provided by Australian and United Kingdom (UK) resuscitation councils.

Methods: The author designed a simulation-based study using a mannequin and a defibrillator, and then recruited six participants. Three participants were certified ALS practitioners who followed UK guidelines, and three were certified ALS practitioners who followed Australian guidelines. Each participant received a random task assignment for each scenario, as a team leader, performer of cardiopulmonary resuscitation, or assistant. The team leader and the chest compressor were unaware of the shockability of each case’s rhythm. Eight minutes total were spent on 10 CPR trials, each lasting four cycles. A video of the simulation was recorded for automated timekeeping. An independent sample t-test was used to compare the amount of hands-off time (seconds) throughout each cycle between two procedures. For purposes of calculating statistical significance, a 0.05 P-value was employed.

Results: The mean duration of second cycle hands-off time (seconds) in the UK ALS protocol was statistically significantly longer than the Australian ALS (t = −2.100; P = 0.05). For shockable rhythms, the hands-off time of the UK ALS protocol was significantly longer than Australian ALS protocol, as reflected in the second cycle (t = −0.621; P < 0.001), third cycle (t = −8.083; P < 0.001), and fourth cycle (t = −5.814; p < 0.001), while the difference in the first cycle between groups was not statistically significant. (t = −0.258; P = 0.803).

Conclusion: This simulation-based study demonstrated that the UK ALS guidelines led to an increased duration of hands-off time during the second cycle. The hands-off time in the shockable rhythms was also higher during the second, third, and fourth cycles in the UK ALS protocol compared to the Australian ALS protocol. These points must be focused on in future revisions of the UKALS guidelines. For better results, it is critical to limit hands-off time between chest compression cycles.