Defibrillation Strategies for Refractory Ventricular Fibrillation

被引：114

作者：

Cheskes, Sheldon ^{[1
,5
,11
]}

Verbeek, P. Richard ^{[2
,5
]}

Drennan, Ian R. R. ^{[1
,6
]}

McLeod, Shelley L. L. ^{[1
,7
]}

Turner, Linda ^{[5
]}

Pinto, Ruxandra ^{[3
,4
]}

Feldman, Michael ^{[5
]}

Davis, Matthew ^{[9
]}

Vaillancourt, Christian ^{[10
]}

Morrison, Laurie J. J. ^{[2
,6
]}

Dorian, Paul ^{[4
,8
]}

Scales, Damon C. C. ^{[3
,4
]}

机构：

[1] Univ Toronto, Dept Family & Commu n Med, Div Emergency Med, Toronto, ON, Canada

[2] Univ Toronto, Div Emergency Med, Dept Med, Toronto, ON, Canada

[3] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[4] Univ Toronto, Dept Med, Toronto, ON, Canada

[5] Sunnybrook Ctr Pre Hosp Med, Dept Emergency Serv, Toronto, ON, Canada

[6] Sunnybrook Ctr Pre Hosp Med, Dept Crit Care Med, Toronto, ON, Canada

[7] Sunnybrook Hlth Sci Ctr, Sinai Hlth, Schwartz Reisman Emergency Med Inst, Toronto, ON, Canada

[8] Unity Hlth Toronto, Div Cardiol, Toronto, ON, Canada

[9] Univ Western Ontario, London Hlth Sci Ctr, Dept Med, Div Emergency Med, London, England

[10] Ottawa Hosp Res Inst, Dept Emergency Med, Ottawa, ON, Canada

[11] Univ Toronto, Temerty Fac Med, Dept Family & Community Med, Div Emergency Med, 77 Browns Line, Ste 100, Toronto, ON M8W 3S2, Canada

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2022年 / 387卷 / 21期

关键词：

SEQUENTIAL EXTERNAL DEFIBRILLATION; AMERICAN-HEART-ASSOCIATION; HOSPITAL CARDIAC-ARREST; CARDIOPULMONARY-RESUSCITATION; RANDOMIZED-TRIALS; GUIDELINES UPDATE; DESIGN; CARDIOVERSION; SURVIVAL; CANADA;

D O I：

10.1056/NEJMoa2207304

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundDespite advances in defibrillation technology, shock-refractory ventricular fibrillation remains common during out-of-hospital cardiac arrest. Double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators) and vector-change (VC) defibrillation (switching defibrillation pads to an anterior-posterior position) have been proposed as defibrillation strategies to improve outcomes in patients with refractory ventricular fibrillation.MethodsWe conducted a cluster-randomized trial with crossover among six Canadian paramedic services to evaluate DSED and VC defibrillation as compared with standard defibrillation in adult patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest. Patients were treated with one of these three techniques according to the strategy that was randomly assigned to the paramedic service. The primary outcome was survival to hospital discharge. Secondary outcomes included termination of ventricular fibrillation, return of spontaneous circulation, and a good neurologic outcome, defined as a modified Rankin scale score of 2 or lower (indicating no symptoms to slight disability) at hospital discharge.ResultsA total of 405 patients were enrolled before the data and safety monitoring board stopped the trial because of the coronavirus disease 2019 pandemic. A total of 136 patients (33.6%) were assigned to receive standard defibrillation, 144 (35.6%) to receive VC defibrillation, and 125 (30.9%) to receive DSED. Survival to hospital discharge was more common in the DSED group than in the standard group (30.4% vs. 13.3%; relative risk, 2.21; 95% confidence interval [CI], 1.33 to 3.67) and more common in the VC group than in the standard group (21.7% vs. 13.3%; relative risk, 1.71; 95% CI, 1.01 to 2.88). DSED but not VC defibrillation was associated with a higher percentage of patients having a good neurologic outcome than standard defibrillation (relative risk, 2.21 [95% CI, 1.26 to 3.88] and 1.48 [95% CI, 0.81 to 2.71], respectively).ConclusionsAmong patients with refractory ventricular fibrillation, survival to hospital discharge occurred more frequently among those who received DSED or VC defibrillation than among those who received standard defibrillation. (Funded by the Heart and Stroke Foundation of Canada; DOSE VF ClinicalTrials.gov number, .)

引用

页码：1947 / 1956

页数：10

共 39 条

[1] Repeated dual external direct cardioversions using two simultaneous 360-J shocks for refractory atrial fibrillation are safe and effective [J].