A high peak current 150-J fixed-energy defibrillation protocol treats recurrent ventricular fibrillation (VF) as effectively as initial VF

Erik P. Hess, James K. Russell, Ping Yu Liu, Roger D. White

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: We tested the hypothesis that the frequency of shock success differs between initial and recurrent episodes of ventricular fibrillation (VF). Methods: Out-of-hospital cardiac arrest patients presenting with VF from December 1996 to February 2007 defibrillated using an AED with a fixed-energy protocol (150 J) (Philips Medical Systems, Seattle, WA) were included for analysis. We defined shock success as termination of VF within 5 s post-shock (either asystole or organized rhythm). Generalized estimating equation (GEE) analysis was used to adjust for the interrelatedness of shocks within each patient. Results: One hundred and three events occurred during the study period. Patient characteristics included: mean age 64.4 years, 82.5% male, and 81.6% bystander witnessed. Synchronized call-to-shock time was 6.4 ± 2.3 min (mean ± S.D.). VF recurred in 64 (62.1%) patients. Two hundred and fifty-seven shocks delivered for initial (101) or recurrent (156) VF were available for analysis. Initial shocks terminated VF in 93/101 (92.1%); subsequent shocks terminated recurrent VF in 140/156 (89.7%). GEE odds ratio for shock type (initial versus refibrillation) was 1.10 (95% CI 0.37-3.24, p = 0.87). After adjusting for potential confounders, shock type remained insignificant (OR 1.14, 95% CI 0.41-3.2, p = 0.80). We observed no significant difference in ROSC (34.4% versus 46.2%, p = 0.23) or survival (37.5% versus 41.0%, p = 0.72) between those with and without VF recurrence. Conclusions: We observed no significant difference in the frequency of shock success between initial and recurrent episodes of VF using this AED with a 150 J fixed-energy protocol. VF recurrence is common and does not adversely affect shock success, ROSC or survival.

Original languageEnglish (US)
Pages (from-to)28-33
Number of pages6
JournalResuscitation
Volume79
Issue number1
DOIs
StatePublished - Oct 2008

Fingerprint

Ventricular Fibrillation
Shock
Out-of-Hospital Cardiac Arrest
Recurrence
Survival
Heart Arrest
Odds Ratio

Keywords

  • Automated external defibrillator (AED)
  • Cardiac arrest
  • Cardiopulmonary resuscitation (CPR)
  • Defibrillation
  • Emergency medical services
  • Resuscitation
  • Return of spontaneous circulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

A high peak current 150-J fixed-energy defibrillation protocol treats recurrent ventricular fibrillation (VF) as effectively as initial VF. / Hess, Erik P.; Russell, James K.; Liu, Ping Yu; White, Roger D.

In: Resuscitation, Vol. 79, No. 1, 10.2008, p. 28-33.

Research output: Contribution to journalArticle

Hess, Erik P. ; Russell, James K. ; Liu, Ping Yu ; White, Roger D. / A high peak current 150-J fixed-energy defibrillation protocol treats recurrent ventricular fibrillation (VF) as effectively as initial VF. In: Resuscitation. 2008 ; Vol. 79, No. 1. pp. 28-33.
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abstract = "Objective: We tested the hypothesis that the frequency of shock success differs between initial and recurrent episodes of ventricular fibrillation (VF). Methods: Out-of-hospital cardiac arrest patients presenting with VF from December 1996 to February 2007 defibrillated using an AED with a fixed-energy protocol (150 J) (Philips Medical Systems, Seattle, WA) were included for analysis. We defined shock success as termination of VF within 5 s post-shock (either asystole or organized rhythm). Generalized estimating equation (GEE) analysis was used to adjust for the interrelatedness of shocks within each patient. Results: One hundred and three events occurred during the study period. Patient characteristics included: mean age 64.4 years, 82.5{\%} male, and 81.6{\%} bystander witnessed. Synchronized call-to-shock time was 6.4 ± 2.3 min (mean ± S.D.). VF recurred in 64 (62.1{\%}) patients. Two hundred and fifty-seven shocks delivered for initial (101) or recurrent (156) VF were available for analysis. Initial shocks terminated VF in 93/101 (92.1{\%}); subsequent shocks terminated recurrent VF in 140/156 (89.7{\%}). GEE odds ratio for shock type (initial versus refibrillation) was 1.10 (95{\%} CI 0.37-3.24, p = 0.87). After adjusting for potential confounders, shock type remained insignificant (OR 1.14, 95{\%} CI 0.41-3.2, p = 0.80). We observed no significant difference in ROSC (34.4{\%} versus 46.2{\%}, p = 0.23) or survival (37.5{\%} versus 41.0{\%}, p = 0.72) between those with and without VF recurrence. Conclusions: We observed no significant difference in the frequency of shock success between initial and recurrent episodes of VF using this AED with a 150 J fixed-energy protocol. VF recurrence is common and does not adversely affect shock success, ROSC or survival.",
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T1 - A high peak current 150-J fixed-energy defibrillation protocol treats recurrent ventricular fibrillation (VF) as effectively as initial VF

AU - Hess, Erik P.

AU - Russell, James K.

AU - Liu, Ping Yu

AU - White, Roger D.

PY - 2008/10

Y1 - 2008/10

N2 - Objective: We tested the hypothesis that the frequency of shock success differs between initial and recurrent episodes of ventricular fibrillation (VF). Methods: Out-of-hospital cardiac arrest patients presenting with VF from December 1996 to February 2007 defibrillated using an AED with a fixed-energy protocol (150 J) (Philips Medical Systems, Seattle, WA) were included for analysis. We defined shock success as termination of VF within 5 s post-shock (either asystole or organized rhythm). Generalized estimating equation (GEE) analysis was used to adjust for the interrelatedness of shocks within each patient. Results: One hundred and three events occurred during the study period. Patient characteristics included: mean age 64.4 years, 82.5% male, and 81.6% bystander witnessed. Synchronized call-to-shock time was 6.4 ± 2.3 min (mean ± S.D.). VF recurred in 64 (62.1%) patients. Two hundred and fifty-seven shocks delivered for initial (101) or recurrent (156) VF were available for analysis. Initial shocks terminated VF in 93/101 (92.1%); subsequent shocks terminated recurrent VF in 140/156 (89.7%). GEE odds ratio for shock type (initial versus refibrillation) was 1.10 (95% CI 0.37-3.24, p = 0.87). After adjusting for potential confounders, shock type remained insignificant (OR 1.14, 95% CI 0.41-3.2, p = 0.80). We observed no significant difference in ROSC (34.4% versus 46.2%, p = 0.23) or survival (37.5% versus 41.0%, p = 0.72) between those with and without VF recurrence. Conclusions: We observed no significant difference in the frequency of shock success between initial and recurrent episodes of VF using this AED with a 150 J fixed-energy protocol. VF recurrence is common and does not adversely affect shock success, ROSC or survival.

AB - Objective: We tested the hypothesis that the frequency of shock success differs between initial and recurrent episodes of ventricular fibrillation (VF). Methods: Out-of-hospital cardiac arrest patients presenting with VF from December 1996 to February 2007 defibrillated using an AED with a fixed-energy protocol (150 J) (Philips Medical Systems, Seattle, WA) were included for analysis. We defined shock success as termination of VF within 5 s post-shock (either asystole or organized rhythm). Generalized estimating equation (GEE) analysis was used to adjust for the interrelatedness of shocks within each patient. Results: One hundred and three events occurred during the study period. Patient characteristics included: mean age 64.4 years, 82.5% male, and 81.6% bystander witnessed. Synchronized call-to-shock time was 6.4 ± 2.3 min (mean ± S.D.). VF recurred in 64 (62.1%) patients. Two hundred and fifty-seven shocks delivered for initial (101) or recurrent (156) VF were available for analysis. Initial shocks terminated VF in 93/101 (92.1%); subsequent shocks terminated recurrent VF in 140/156 (89.7%). GEE odds ratio for shock type (initial versus refibrillation) was 1.10 (95% CI 0.37-3.24, p = 0.87). After adjusting for potential confounders, shock type remained insignificant (OR 1.14, 95% CI 0.41-3.2, p = 0.80). We observed no significant difference in ROSC (34.4% versus 46.2%, p = 0.23) or survival (37.5% versus 41.0%, p = 0.72) between those with and without VF recurrence. Conclusions: We observed no significant difference in the frequency of shock success between initial and recurrent episodes of VF using this AED with a 150 J fixed-energy protocol. VF recurrence is common and does not adversely affect shock success, ROSC or survival.

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KW - Cardiac arrest

KW - Cardiopulmonary resuscitation (CPR)

KW - Defibrillation

KW - Emergency medical services

KW - Resuscitation

KW - Return of spontaneous circulation

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