Early double sequential defibrillation for out-of-hospital cardiac arrest appears feasible and safe, with no alarming safety risks observed among the first 34 patients in this pilot study.
RCT (n=34)
3:1 allocation
Is early double sequential defibrillation safe and feasible in adults with out-of-hospital cardiac arrest and a shockable rhythm?
Early double sequential defibrillation appears feasible and safe in patients with out-of-hospital cardiac arrest and a shockable rhythm, supporting progression to a full-scale randomized trial.
Abstract Background Out-of-hospital cardiac arrest (OHCA) affects about 270,000 individuals in Europe annually. In OHCA, presenting with shockable rhythm are among the strongest predictors of survival (1). Patients with ventricular fibrillation (VF) who have not regained spontaneous circulation after three defibrillations are considered to have refractory ventricular fibrillation. In 2022 a prospective cluster randomized trial showed increased survival among OHCA patients in refractory VF using an alternative defibrillation strategy, double sequential defibrillation (2). Double sequential defibrillation can currently be considered for adults with cardiac arrest who remain in shockable rhythm despite three defibrillations. A study recently published showed a decreased survival associated with each additional defibrillation regardless of refractoriness or not (3). Early double sequential defibrillation has never been tested before and the aim of this pilot study is to evaluate feasibility and safety of early double sequential defibrillation in OHCA before a planned full scale randomized trial. Methods A randomized controlled pilot study, start in June 2024. 3:1 allocation (3 double sequential defibrillation, 1 standard) including 40 patients. Inclusion criteria are: OHCA patients ≥18 years, with shockable rhythm and at least one defibrillation performed. Inclusion is possible when there are two study-specific defibrillators on site. Primary endpoints are safety and feasibility. Data is collected from study questionnaire, ECG from defibrillators, medical charts and follow-up interview with emergency medical services (EMS) crew. Results Currently 34 patients have been included. 19/34 patients were included after one defibrillation and 4/34 were defibrillated with automated external defibrillator prior to EMS arrival. No alarming safety risks regarding defibrillators or CPR quality have been observed. In one case, difficulty of double sequential defibrillation due to semi-automatic setting was reported. Conclusion This is the first ever trial evaluating early double sequential defibrillation in OHCA. In this pilot study we found that the strategy of early double sequential defibrillation is feasible in the existing study area. It appears to be safe to perform early double sequential defibrillation according to the study method. It is possible to measure the time between the double sequential defibrillations on the ECG from the defibrillators used.ECG Double sequential defibrillation
Nordkvist et al. (Sat,) conducted a rct in Out-of-hospital cardiac arrest (OHCA) with shockable rhythm (n=34). Early double sequential defibrillation vs. Standard defibrillation was evaluated on Safety and feasibility. Early double sequential defibrillation for out-of-hospital cardiac arrest appears feasible and safe, with no alarming safety risks observed among the first 34 patients in this pilot study.
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