During ACLS, valuable seconds are often wasted while trying to analyze the rhythm on the tiny monitor. Is it VT? VF? PEA? Then when we decide we do want to deliver the shock, even more time is wasted charging the defibrillator. All this lost time translates to decreased time delivering perfusion-delivering compressions in critically ill patients.

Sam Ghali, EM Faculty at the University of Kentucky, is a vocal proponent of pre-charging the defibrillator during codes, and points out that coronary perfusion pressure (CPP) actually takes time to build up. Often, after an entire cycle of compressions we are only just starting to generate enough pressure to perfuse the coronaries, only to lose it during the subsequent pulse check. By pre-charging the defibrillator, this time can be decreased substantially, increasing the likelihood of achieving ROSC in the patient with coronary ischemia.

So next time you’re running a code, consider assigning a person to charge the defibrillator before your pulse check, so as soon as you see that shockable rhythm you’re ready to go!

Edelson, DP et al. Safety and efficacy of defibrillator charging during ongoing chest compressions: a multi-center study. Resuscitation. 2010 Nov;81(11):1521-6. PMID: 20807672.

Lin, Michelle, et al. “Lin Sessions – Precharging the Defibrillator.” November 2016. https://www.emrap.org/episode/penetratingthe/linsessions