“To shock or not to shock? This is no longer a question”…with the new AED technologies

Minimally interrupted chest compression (CC) combined with prompt defibrillation is crucial to ensure high-quality cardiopulmonary resuscitation (CPR) and improve survival after cardiac arrest (CA).1 Chest compression fraction (CCF) is therefore a key measure of CPR quality.2,3 Evidence suggests that higher CCF is predictive of better survival, leading current guidelines to recommend a CCF target ≥ 60%, although some cases require over 80% for favorable neurological outcome.2,4–8 However, resuscitative efforts are often unsuccessful due to frequent CC interruptions, which cause rapid decline in myocardial perfusion and defibrillation success.1,9,10 Among the different causes of CC interruptions, are the pre-shock pauses mandated by automated external defibrillators (AEDs) for rhythm analysis, ranging from 12 to 46 sec and accounting for up to 40% of the CPR duration.11–13 Thus, researchers and device manufacturers have focused on minimizing these interruptions as strategy to potentially improve outcomes.11–18