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Cardiac arrest - out of hospital care - Management
Basis for recommendation

These recommendations are based on guidelines from the Resuscitation Council (UK) [Resusucitation Council, 2010].

Basis for undertaking cardiopulmonary resuscitation before defibrillation

  • Evidence indicates that a period of cardiopulmonary resuscitation (CPR) before defibrillation may improve survival after prolonged collapse (greater than 5 minutes) [Wik et al, 2003]. The duration of collapse is frequently difficult to estimate accurately, so it is recommended to give CPR before attempting defibrillation outside hospital, unless the arrest is witnessed by a healthcare professional or an automated external defibrillator (AED) is being used. This advice does NOT apply to lay responders using an AED outside hospital, who should apply the AED as soon as it is available.

Basis for not shocking someone in fine ventricular fibrillation

  • Fine ventricular fibrillation (VF) that is difficult to distinguish from asystole is unlikely to be shocked successfully into a perfusing rhythm. Continuing good quality CPR may improve the amplitude and frequency of the VF and improve the chance of successful defibrillation to a perfusing rhythm. Delivering repeated shocks in an attempt to defibrillate what is thought to be fine VF will increase myocardial injury, both directly from the electric current and indirectly from the interruptions in coronary blood flow.

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