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For every minute of delay to shock in ventricular fibrillation (VF) arrest, the proportion of successful first shocks decreases by 6%. When the first shock is delivered within 2 minutes, success is 95% but drops to 75% when the delay exceeds 6 minutes.
Shock early and often, but hopefully just once
This large ARREST registry study investigates the impact of the time delay from emergency call to first defibrillation on outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA), with VF as the initial rhythm. Authors identified 3,723 patients in the registry with VF arrest and data on first-shock timing and outcomes. For every one minute delay in defibrillation, VF termination and survival to discharge both dropped 6%. Rapid response not only affects termination of VF but overall patient outcomes, indicating that early defibrillation leads to fewer unsuccessful attempts and improved myocardial energy restoration. The data suggest that a first shock within 6 minutes is critical for optimal outcomes, with the proportion of successful defibrillations decreasing significantly when the interval extends beyond this timeline.
How will this change my practice?
As healthcare professionals, we should continue to advocate for layperson knowledge of CPR and defibrillator use. Early responses are the first domino in the cascade of events which result in optimal outcomes in OHCA. I will continue to advocate for widespread AED availability and layperson training, as they are the most crucial link in witnessed OHCA survival.
Source
Association Between Delay to First Shock and Successful First-Shock Ventricular Fibrillation Termination in Patients With Witnessed Out-of-Hospital Cardiac Arrest. Circulation. 2024 Oct 27. doi: 10.1161/CIRCULATIONAHA.124.069834. Epub ahead of print. PMID: 39462804
