Analysis/Defibrillation While Transporting
Question# 759
Can you perform defibrillation while in a moving vehicle?
Answer:
Previously, the teaching was to focus on high quality CPR once transport has been initiated and continued defibrillation was de-emphasized as ongoing analysis interrupt CPR and there is a potential of an inaccurate rhythm interpretation.
Since Dr. Cheskes DSED study, new evidence suggests that ongoing defibrillation is beneficial especially in those who are in refractory VT or VF.
That said, the Companion Document does state the following regarding SAED:
"When en-route and using semi-automated rhythm analysis, the ambulance must be stopped to minimize artifact and the risk of an inaccurate rhythm interpretation/analysis." (p. 6). This is consistent with both the Zoll X Series and Lifepack 15 manufacturer guidelines.
If using manual mode, it is paramedic discretion using clinical judgement to continue rhythm interpretation/defibrillation once transport has been initiated. It is acceptable to analyze/deliver a shock in a moving vehicle however, there should be a risk benefit approach as with anything we do. There should still be a focus on high quality CPR and you should be certain of the patient's rhythm and that it is not artifact you are seeing on the monitor. Remember, "Following the initial pulse check, subsequent pulse checks are indicated when a rhythm interpretation/analysis reveals a non-shockable rhythm (PEA or Asystole), or there are signs of life present." (Companion Document p. 7).
Once transport has been initiated, pulling the ambulance over to analyze/defibrillate would be recommended against unless using SAED and the patient was a ROSC and re-arrested en-route in which case the paramedics would pull over, initiate one rhythm interpretation/analysis, treat the rhythm appropriately, and continue with transport to receiving facility with no further stops (Companion Document p. 6).
We hope this is valuable information that can be incorporated into your future clinical practice.
Since Dr. Cheskes DSED study, new evidence suggests that ongoing defibrillation is beneficial especially in those who are in refractory VT or VF.
That said, the Companion Document does state the following regarding SAED:
"When en-route and using semi-automated rhythm analysis, the ambulance must be stopped to minimize artifact and the risk of an inaccurate rhythm interpretation/analysis." (p. 6). This is consistent with both the Zoll X Series and Lifepack 15 manufacturer guidelines.
If using manual mode, it is paramedic discretion using clinical judgement to continue rhythm interpretation/defibrillation once transport has been initiated. It is acceptable to analyze/deliver a shock in a moving vehicle however, there should be a risk benefit approach as with anything we do. There should still be a focus on high quality CPR and you should be certain of the patient's rhythm and that it is not artifact you are seeing on the monitor. Remember, "Following the initial pulse check, subsequent pulse checks are indicated when a rhythm interpretation/analysis reveals a non-shockable rhythm (PEA or Asystole), or there are signs of life present." (Companion Document p. 7).
Once transport has been initiated, pulling the ambulance over to analyze/defibrillate would be recommended against unless using SAED and the patient was a ROSC and re-arrested en-route in which case the paramedics would pull over, initiate one rhythm interpretation/analysis, treat the rhythm appropriately, and continue with transport to receiving facility with no further stops (Companion Document p. 6).
We hope this is valuable information that can be incorporated into your future clinical practice.
References
Companion Document p. 6-7