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 and 1.48, respectively).Īmong 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. 13.3% relative risk, 2.21 95% confidence interval, 1.33 to 3.67) and more common in the VC group than in the standard group (21.7% vs. Survival to hospital discharge was more common in the DSED group than in the standard group (30.4% vs. 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. 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.Ī total of 405 patients were enrolled before the data and safety monitoring board stopped the trial because of the coronavirus disease 2019 pandemic. The primary outcome was survival to hospital discharge. Patients were treated with one of these three techniques according to the strategy that was randomly assigned to the paramedic service. We 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. 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. 1 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.) - all in Canada.ĭespite advances in defibrillation technology, shock-refractory ventricular fibrillation remains common during out-of-hospital cardiac arrest.
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