COACHED Breakdown
Apr 04, 2025
C.O.A.C.H.E.D breakdown
🩺 High quality CPR with minimal interruption is the foundation of advanced life support and a critical element in maximising positive outcomes. The use of a cognitive aid, such as COACHED, has been shown to improve “time off the chest” and provides a structured, standardised approach which minimises interruptions and promotes provider safety.
💡 If COACHED is a new term to you, don’t worry! Let us break it down for you!
The staff member running the defibrillator runs through each of the following steps in the lead up to a rhythm analysis, usually in conjunction with the team leader.
✅ C: Continue compressions
💬 Communication to the CPR provider lets them know that a rhythm analysis is approaching and that they should continue with compressions.
🩸 O: Oxygen away
🚨 Free flowing oxygen via BVM needs to be removed from the patient area. If the patient has an advanced airway placed with a closed circuit, this can remain, however the “airway” person needs to stand clear.
🔬 A: All else clear
🧑⚕️ All other staff EXCEPT for the CPR provider need to stand clear of the patient/bed. At this stage, a visual sweep of the patient “top, middle, bottom” can be made to ensure all other staff are standing clear. This step is critical, as it is often where confusion occurs and CPR interruptions occur if the CPR provider does not understand the COACHED process.
⚡ C: Charging
🔋 At this stage, the defibrillator is charged. CPR remains in progress.
✋ H: Hands off
🛑 When the defibrillator has reached full charge, this is the point at which CPR is paused. The defib operator declares loudly “hands off”, and the CPR provider stops, stands clear of the patient, and declares “I’m safe.”
💓 E: Evaluate the rhythm
👀 With CPR paused, the underlying rhythm can be analysed to determine which pathway the patient is in. Confirmation of the rhythm is usually decided between the defib operator and the team leader.
💥 D: Deliver shock/disarm
🔌 If the patient is in a shockable pathway, the shock is delivered. If they are in a non-shockable pathway, the shock is “dumped” or disarmed. This is another crucial step, particularly in the non-shockable pathway, as there is the chance that CPR is recommenced before the shock is “dumped”, which is a major safety concern.
🧠 If using this cognitive aid, it is important to ensure that all providers understand the process involved and the underlying aim of the aid - bearing in mind that CPR providers might only be trained in basic life support. As with any crisis scenario, the effectiveness of this aid relies on clear communication and a shared mental model.
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References:
Coggins, A., Nottingham, C., Chin, M., Warburton, S., Han, M., Murphy, M., Sutherland, J., Moore, N. (2018). A prospective evaluation of the ‘C.O.A.C.H.E.D’ cognitive aid for emergency defibrillation. Australasian Emergency Care. V 21(3) pp 81-86. https://doi.org/10.1016/j.auec.2018.08.002
Ionmhain, U.N. (2020). Defibrillation basics. Life in the fastlane. https://litfl.com/defibrillation-basics/
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