Defibrillation methods for refractory ventricular fibrillation
Regardless of advances in defibrillation expertise, shock-refractory ventricular fibrillation stays a standard incidence throughout out-of-hospital cardiac arrest. Twin sequential exterior defibrillation (DSED; fast sequential shocks from two defibrillators) and vector-change (VC) defibrillation (switching defibrillation pads to an anterior-posterior place) have been proposed as defibrillation methods to enhance outcomes in sufferers with refractory ventricular fibrillation.
We carried out a cluster-randomized, cross-over trial amongst six Canadian paramedic providers to judge DSED and VC defibrillation versus commonplace defibrillation in grownup sufferers with refractory ventricular fibrillation throughout out-of-hospital cardiac arrest. Sufferers have been handled with one in every of these three strategies in line with a method that was randomly assigned to the paramedic service. The first consequence was survival to hospital discharge. Secondary outcomes included cessation of ventricular fibrillation, restoration of spontaneous circulation, and good neurologic consequence, outlined as a modified Rankin rating of two or much less (indicating no signs of gentle incapacity) at hospital discharge.
A complete of 405 sufferers have been enrolled earlier than the info and security monitoring board stopped the trial as a result of 2019 coronavirus pandemic. A complete of 136 sufferers (33.6%) obtained commonplace defibrillation, 144 (35.6%) – VC defibrillation and 125 (30.9%) – DSED. Survival to hospital discharge was extra widespread within the DSED group than in the usual group (30.4% vs 13.3%; relative danger 2.21; 95% CI [CI], 1.33 to three.67) and extra widespread within the VC group than in the usual group (21.7% vs. 13.3%; relative danger, 1.71; 95% CI, 1.01 to 2.88) . DSED however not VC defibrillation was related to the next share of sufferers with a great neurologic consequence than commonplace defibrillation (relative danger, 2.21 [95% CI, 1.26 to 3.88] and 1.48 [95% CI, 0.81 to 2.71]respectively).
Amongst sufferers with refractory ventricular fibrillation, survival to hospital discharge was better amongst those that obtained DSED or VC defibrillation than amongst those that obtained commonplace defibrillation. (Funded by the Coronary heart and Stroke Basis of Canada; ClinicalTrials.gov quantity DOSE VF, NCT04080986.)
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