Anticipatory manual defibrillator charging during advanced life support: A scoping review

BACKGROUND: Some resuscitation services advocate or teach routine manual defibrillator charging prior to a rhythm check during cardiopulmonary resuscitation.

OBJECTIVES: We aimed to review the evidence for anticipatory defibrillator charging compared with charging after a shockable rhythm is confirmed.

METHODS: This scoping review was performed according to a specific methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Grey literature was also reviewed using similar methodology and included in the results.

RESULTS: There are no randomized clinical trials studying anticipatory manual defibrillator charging. The limited available data does not address critical or important patient outcomes such as defibrillation success, return of spontaneous circulation, survival to hospital discharge or neurological outcomes. Evidence primarily from manikin studies and the grey literature suggests that anticipatory charging is feasible, safe, and can reduce the total pause duration during the period of chest compression between rhythm checks, but can increase the pre-shock pause and total peri-shock pause duration.

CONCLUSIONS: Anticipatory manual defibrillator charging appears to be feasible in the clinical setting, although its impact on clinical outcomes is uncertain. Future studies of anticipatory charging should focus on clinical outcomes.