Randomization of treatment sequences was computer-generated by the coordinating center at the level of paramedic service prior to the start of the trial. It was later terminated in May 2022 from concerns that longer response times due to paramedic staffing shortages were interfering with the timely application of the assigned type of defibrillation. The trial ran from September 2019 to May 2022 and was interrupted from April 2020 to September 2020 due to the COVID-19 pandemic. This study is a three-group, cluster-randomized controlled trial with cross-over conducted with 6 paramedic services in urban and rural communities with a population of 6.6 million. This study is a randomized control trial designed to evaluate the early use of DSED and VC techniques in refractory ventricular fibrillation. A further confounder in previous studies is a lack of timing considerations of DSED/DSD/VC as they may have been used as a last resort vs. 4 In addition, there is a theoretical risk of defibrillator damage with multiple shocks. 3 Due to this uncertainty, practice both in and out of hospital have not incorporated these alternative techniques for defibrillation into the current cardiac arrest guidelines. These defibrillation techniques have been reported in previous observational studies with varying degrees of success. Another mode exists, double simultaneous defibrillation (DSD), in which the pads are in AL and AP configuration but the shocks are delivered simultaneously. Both shocks are immediately given sequentially. One set is placed in the AL position and the other in the AP configurations. This may allow for a higher current to pass through portions of the ventricle not reached by the standard AL position. In VC defibrillation, the pads are switched from the standard anterior-lateral (AL) to an anterior-posterior (AP) position to change the vector of the electrical shock. Two of these are DSED and VC defibrillation. Several alternative defibrillator techniques have been proposed. 1 Following defibrillation, advanced cardiac life support (ACLS) promotes the use of antiarrhythmics, but no antiarrhythmic has been shown to improve neurologically intact survival. Previous literature has found that 30-day survival is 28.7% in patients who can be cardioverted in the first three shocks survival drops to 4.9% among those needing >10 shocks for successful cardioversion. Despite this, some patients remain in refractory ventricular fibrillation, which is usually defined as persistent ventricular fibrillation after three defibrillation attempts. Ventricular fibrillation and pulseless ventricular tachycardia have a higher chance of survival than other cardiac rhythms during cardiac arrest. Standard guidelines promote early defibrillation for cessation of the arrhythmia. Ventricular fibrillation contributes to a significant portion of out-of-hospital cardiac arrest. OBJECTIVE: To evaluate double sequential external defibrillation (DSED) and vector-change defibrillation (VC) as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest. Defibrillation Strategies for Refractory Ventricular Fibrillation. ARTICLE:Cheskes S, Verbeek PR, Drennan IR, et al.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |