Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest

Beck, Lauren R; Ostermayer, Daniel; Ponce, Joseph N; Srinivasan, Saranya; Wang, Henry E.

doi:10.1080/10903127.2019.1584256

Cited by 36 publications

(40 citation statements)

References 12 publications

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“…For the critical outcomes of survival with favourable neurological outcome 29 , 30 , 31 and survival to hospital discharge 29 , 30 , 31 , 32 , 33 , 34 and the important outcomes of survival to hospital admission, 29 , 30 , 32 , 33 ROSC, 29 , 30 , 31 , 32 , 33 , 34 , 35 and termination of VF, 31 , 34 , 35 we identified only observational studies. The overall certainty of evidence was rated as very low for all outcomes, primarily because of a very serious risk of bias.…”

Section: Defibrillation Strategies For Ventricular Fibrillation or Pumentioning

confidence: 99%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

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Section: Defibrillation Strategies For Ventricular Fibrillation or Pumentioning

confidence: 99%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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“…Various EMS strategies have attempted to improve the provision of defibrillation in the prehospital setting. [3][4][5] However, not all patients with an initial shockable rhythm respond to defibrillation, even after several attempts.…”

Section: Introductionmentioning

confidence: 99%

Association between the number of prehospital defibrillation attempts and neurologic outcomes in out-of-hospital cardiac arrest patients without on-scene return of spontaneous circulation

et al. 2021

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Objective Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients.Methods A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2-3, 4-5, and ≥ 6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts.Results A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2-3, 4-5, and ≥ 6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥ 6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21-0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21-0.84). ConclusionSix or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.

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“…For example, while available and encouraged throughout the study period, only ~ 20% of RVF patients in both the pre-and post-esmolol groups received DSD. While the current evidence for the e cacy of DSD in RVF is mixed (17,18), it is possible that increased DSD use in conjunction with esmolol administration could potentially lead to improved outcomes. Also, due to having relatively short EMS transport times and to minimize logistical complexities, we elected to defer initiation of an esmolol drip within our protocol.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Prehospital Esmolol for Refractory Ventricular Fibrillation

Patrick

Crowe²,

Mohammed³

et al. 2021

Preprint

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Background: We aimed to assess the feasibility of prehospital bolus dose esmolol for patients with out-of-hospital cardiac arrest (OHCA) and refractory ventricular fibrillation (RVF) treated by a single, high-volume, ground-based emergency medical services (EMS) agency. Methods: This retrospective observational study evaluated EMS patients with RVF treated from June 10, 2017 to June 10, 2020. Esmolol (0.5mg/kg bolus) was added to the RVF protocol at the mid-point of the study period on December 10, 2018. Results: We analyzed 61 patients treated with prehospital esmolol and 63 patients treated without esmolol. Median time from EMS arrival to esmolol administration was 17 minutes (interquartile range: 13-22 minutes). Prehospital return of spontaneous circulation (ROSC) was higher in the esmolol group compared to the control group, though statistical significance was not reached (38% versus 24%, p=0.09). Overall, few patients survived to 24 hours (esmolol n=15, pre-esmolol n=16) and fewer survived to hospital discharge (esmolol n=5, pre-esmolol n=5), precluding stable statistical comparisons. Conclusion: Our findings suggest that esmolol is feasible in the prehospital setting and may lead to increased ROSC. Further large-scale studies are needed to determine the effect of prehospital esmolol for RVF as it relates to survival to hospital discharge.Trial Registration: This study was approved by the institutional review board at The Baylor College of Medicine and a waiver of informed consent was granted - protocol number H-48383.

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Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest

Cited by 36 publications

References 12 publications

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Association between the number of prehospital defibrillation attempts and neurologic outcomes in out-of-hospital cardiac arrest patients without on-scene return of spontaneous circulation

Feasibility and Efficacy of Prehospital Esmolol for Refractory Ventricular Fibrillation

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