This study was limited by not specifying a fixed follow-up time, and the length of stay distributions across the trial centers is unknown. ![]() Overall, this study found that survival to hospital discharge was higher with DSED and VC defibrillation as compared to standard defibrillation in patients with refractory ventricular fibrillation. However, there is a gap in knowledge regarding the effectiveness of DSED and VC defibrillation compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest. DSED and VC have been proposed to provide potential benefits in defibrillating a portion of the ventricle that may not be completely defibrillated by pads in the standard anterior-lateral position. Almost half of these patients may remain in refractory ventricular fibrillation despite multiple defibrillation attempts. The primary objectives of the pilot study are to determine the feasibility and required sample size of a full-scale RCT in this population.There are over 350,000 unexpected deaths each year in North America due to out-of-hospital cardiac arrest, with 100,000 of these cases attributed to ventricular fibrillation or pulseless ventricular tachycardia. Outcomes of interest will include return of spontaneous circulation (ROSC), termination of VF after the first interventional shock, termination of VF inclusive of all interventional shocks, and number of defibrillation attempts to obtain ROSC. The cluster units will be defined by emergency medical service (EMS) agency and each cluster will crossover at three times during the trial so that each agency will spend 4 months in each arm of the study. ![]() This pilot cluster randomized trial will be conducted in the regions of Peel, Halton, Simcoe, and the city of Toronto, Ontario, Canada over a one year period of time.Īll adult (≥ 18 years) patients presenting in refractory VF (defined as patients presenting in VF and remaining in VF after three consecutive standard defibrillation attempts each separated by 2 minutes of CPR) during out-of-hospital cardiac arrest of presumed cardiac etiology will be assigned to be treated by one of three strategies: (1) continued resuscitation using standard defibrillation (2) resuscitation involving DSED (two defibrillators, one using anterior-posterior pad placement and the second using anterior- anterior pad placement delivering two rapid sequential shocks for all subsequent defibrillation attempts, ± antiarrythmic use and epinephrine as per current provincial standard) or (3) resuscitation involving vector change (change of defibrillation pads from anterior-anterior to an anterior-posterior pad position) defibrillation. ![]() However, currently there is insufficient evidence to support a widespread implementation of this therapy.Īs such, a well-designed randomized controlled trial (RCT) employing a standardized approach to alternative defibrillation strategies early in the treatment of refractory VF is required to determine whether these treatments may impact clinical outcomes. Double sequential external defibrillation (DSED) and vector change defibrillation have been proposed as viable options for patients in refractory ventricular fibrillation (VF) during out-of-hospital cardiac arrest.
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