Rhythm analysis and defibrillation during transport

The preferred approach is to continue rhythm analysis every two minutes during transport and defibrillate when indicated. If you can confidently identify a shockable rhythm and safely deliver a shock while the ambulance is moving, do so without stopping, keeping the interruption in CPR as brief as possible (American Heart Association, 2025).

When movement prevents a reliable interpretation, troubleshoot the artifact first. If you still cannot determine the rhythm, consider whether pulling over would allow you to deliver treatment that is likely to make a difference for this patient. A brief, safe stop may be worthwhile when the patient has remained shockable or when you have another reasonable basis to believe that obtaining a clear tracing will change their care.

For a patient who has remained asystolic, or whose arrest has continued despite repeated defibrillation, pulling over every two minutes may add substantial delay without a reasonable expectation of benefit. That does not mean further defibrillation cannot help or that rhythm assessment should stop; it means the decision to interrupt transport should reflect the patient’s course, the reliability of the tracing and the likelihood that stopping will allow a useful intervention.

Continue to assess the rhythm whenever you can do so reliably, and use clinical judgment when artifact makes that difficult. The goal is to maintain effective CPR and provide timely defibrillation while avoiding repeated stops that are unlikely to improve care.