Abstract
Background
Despite advances successful defibrillation technology, shock-refractory ventricular fibrillation remains communal during out-of-hospital cardiac arrest. Double sequential outer defibrillation (DSED; accelerated sequential shocks from 2 defibrillators) and vector-change (VC) defibrillation (switching defibrillation pads to an anterior–posterior position) person been projected arsenic defibrillation strategies to amended outcomes successful patients with refractory ventricular fibrillation.
Methods
We conducted a cluster-randomized proceedings with crossover among six Canadian paramedic services to measure DSED and VC defibrillation arsenic compared with modular defibrillation successful big patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest. Patients were treated with 1 of these 3 techniques according to the strategy that was randomly assigned to the paramedic service. The superior result was endurance to infirmary discharge. Secondary outcomes included termination of ventricular fibrillation, instrumentality of spontaneous circulation, and a bully neurologic outcome, defined arsenic a modified Rankin standard people of 2 oregon little (indicating nary symptoms to flimsy disability) astatine infirmary discharge.
Results
A full of 405 patients were enrolled earlier the information and information monitoring committee stopped the proceedings due to the fact that of the coronavirus illness 2019 pandemic. A full of 136 patients (33.6%) were assigned to person modular defibrillation, 144 (35.6%) to person VC defibrillation, and 125 (30.9%) to person DSED. Survival to infirmary discharge was much communal successful the DSED radical than successful the modular radical (30.4% vs. 13.3%; comparative risk, 2.21; 95% assurance interval [CI], 1.33 to 3.67) and much communal successful the VC radical than successful the modular radical (21.7% vs. 13.3%; comparative risk, 1.71; 95% CI, 1.01 to 2.88). DSED but not VC defibrillation was associated with a higher percent of patients having a bully neurologic result than modular defibrillation (relative risk, 2.21 [95% CI, 1.26 to 3.88] and 1.48 [95% CI, 0.81 to 2.71], respectively).
Conclusions
Among patients with refractory ventricular fibrillation, endurance to infirmary discharge occurred much often among those who received DSED oregon VC defibrillation than among those who received modular defibrillation. (Funded by the Heart and Stroke Foundation of Canada; DOSE VF ClinicalTrials.gov number, NCT04080986.)
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Sign InFunding and Disclosures
Supported by the Heart and Stroke Foundation of Canada Grant-in-Aid program.
Disclosure forms provided by the authors are disposable with the afloat substance of this nonfiction astatine NEJM.org.
Drs. Dorian and Scales contributed arsenic to this article.
This nonfiction was published connected November 6, 2022, astatine NEJM.org.
A data sharing statement provided by the authors is disposable with the afloat substance of this nonfiction astatine NEJM.org.
Author Affiliations
From the Division of Emergency Medicine, Department of Family and Community Medicine (S.C., I.R.D., S.L.M.), the Division of Emergency Medicine, Department of Medicine, (P.R.V., L.J.M.), the Interdepartmental Division of Critical Care Medicine (R.P., D.C.S.), and the Department of Medicine (R.P., P.D., D.C.S.), Temerty Faculty of Medicine, University of Toronto, the Sunnybrook Centre for Prehospital Medicine (S.C., P.R.V., L.T., M.F.), the Departments of Emergency Services (I.R.D., L.J.M.) and Critical Care Medicine (R.P., D.C.S.), Sunnybrook Health Sciences Centre, the Schwartz/Reisman Emergency Medicine Institute, Sinai Health (S.L.M.), and the Division of Cardiology, Unity Health Toronto (P.D.), Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Medicine, University of Western Ontario, London (M.D.), and the Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa (C.V.) — each successful Canada.
Dr. Cheskes tin beryllium contacted astatine [email protected] oregon astatine the Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 77 Browns Line, Ste. 100, Toronto, Ontario M8W 3S2, Canada.
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