Performance of a rectilinear biphasic waveform in defibrillation of presenting and recurrent ventricular fibrillation: A prospective multicenter study

Erik P. Hess, Dipti Agarwal, Lucas A. Myers, Elizabeth J. Atkinson, Roger D. White

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: We tested the hypothesis that shock success differs with initial and recurrent episodes of ventricular fibrillation (VF). Methods: From September 2008 to March 2010 out-of-hospital cardiac arrest patients with VF as the initial rhythm at 9 study sites were defibrillated by paramedics using a rectilinear biphasic waveform. Shock success was defined as termination of VF within 5. s post-shock. We used generalized estimating equation (GEE) analysis to assess the association between shock type (initial versus refibrillation) and shock success. Results: Ninety-four patients presented in VF. Mean age was 65.4 years, 78.7% were male, and 80.9% were bystander-witnessed. VF recurred in 75 (79.8%). There were 338 shocks delivered for initial (n= 90) or recurrent (n= 248) VF available for analysis. Initial shocks terminated VF in 79/90 (87.8%) and subsequent shocks in 209/248 (84.3%). GEE odds ratio (OR) for shock type was 1.37 (95% CI 0.68-2.74). After adjusting for potential confounders, the OR for shock type remained insignificant (1.33, 95% CI 0.60-2.53). We observed no significant difference in ROSC (54.7% versus 52.6%, absolute difference 2.1%, p= 0.87) or neurologically intact survival to hospital discharge (21.9% versus 33.3%, absolute difference 11.4%, p= 0.31) between those with and without VF recurrence. Conclusions: Presenting VF was terminated with one shock in 87.8% of cases. We observed no significant difference in the frequency of shock success between initial versus recurrent VF. VF recurred in the majority of patients and did not adversely affect shock success, ROSC, or survival.

Original languageEnglish (US)
Pages (from-to)685-689
Number of pages5
JournalResuscitation
Volume82
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Ventricular Fibrillation
Multicenter Studies
Shock
Prospective Studies
Odds Ratio
Out-of-Hospital Cardiac Arrest
Allied Health Personnel
Survival

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Defibrillation
  • Emergency medical services
  • Resuscitation
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Performance of a rectilinear biphasic waveform in defibrillation of presenting and recurrent ventricular fibrillation : A prospective multicenter study. / Hess, Erik P.; Agarwal, Dipti; Myers, Lucas A.; Atkinson, Elizabeth J.; White, Roger D.

In: Resuscitation, Vol. 82, No. 6, 06.2011, p. 685-689.

Research output: Contribution to journalArticle

Hess, Erik P. ; Agarwal, Dipti ; Myers, Lucas A. ; Atkinson, Elizabeth J. ; White, Roger D. / Performance of a rectilinear biphasic waveform in defibrillation of presenting and recurrent ventricular fibrillation : A prospective multicenter study. In: Resuscitation. 2011 ; Vol. 82, No. 6. pp. 685-689.
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T1 - Performance of a rectilinear biphasic waveform in defibrillation of presenting and recurrent ventricular fibrillation

T2 - A prospective multicenter study

AU - Hess, Erik P.

AU - Agarwal, Dipti

AU - Myers, Lucas A.

AU - Atkinson, Elizabeth J.

AU - White, Roger D.

PY - 2011/6

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N2 - Objectives: We tested the hypothesis that shock success differs with initial and recurrent episodes of ventricular fibrillation (VF). Methods: From September 2008 to March 2010 out-of-hospital cardiac arrest patients with VF as the initial rhythm at 9 study sites were defibrillated by paramedics using a rectilinear biphasic waveform. Shock success was defined as termination of VF within 5. s post-shock. We used generalized estimating equation (GEE) analysis to assess the association between shock type (initial versus refibrillation) and shock success. Results: Ninety-four patients presented in VF. Mean age was 65.4 years, 78.7% were male, and 80.9% were bystander-witnessed. VF recurred in 75 (79.8%). There were 338 shocks delivered for initial (n= 90) or recurrent (n= 248) VF available for analysis. Initial shocks terminated VF in 79/90 (87.8%) and subsequent shocks in 209/248 (84.3%). GEE odds ratio (OR) for shock type was 1.37 (95% CI 0.68-2.74). After adjusting for potential confounders, the OR for shock type remained insignificant (1.33, 95% CI 0.60-2.53). We observed no significant difference in ROSC (54.7% versus 52.6%, absolute difference 2.1%, p= 0.87) or neurologically intact survival to hospital discharge (21.9% versus 33.3%, absolute difference 11.4%, p= 0.31) between those with and without VF recurrence. Conclusions: Presenting VF was terminated with one shock in 87.8% of cases. We observed no significant difference in the frequency of shock success between initial versus recurrent VF. VF recurred in the majority of patients and did not adversely affect shock success, ROSC, or survival.

AB - Objectives: We tested the hypothesis that shock success differs with initial and recurrent episodes of ventricular fibrillation (VF). Methods: From September 2008 to March 2010 out-of-hospital cardiac arrest patients with VF as the initial rhythm at 9 study sites were defibrillated by paramedics using a rectilinear biphasic waveform. Shock success was defined as termination of VF within 5. s post-shock. We used generalized estimating equation (GEE) analysis to assess the association between shock type (initial versus refibrillation) and shock success. Results: Ninety-four patients presented in VF. Mean age was 65.4 years, 78.7% were male, and 80.9% were bystander-witnessed. VF recurred in 75 (79.8%). There were 338 shocks delivered for initial (n= 90) or recurrent (n= 248) VF available for analysis. Initial shocks terminated VF in 79/90 (87.8%) and subsequent shocks in 209/248 (84.3%). GEE odds ratio (OR) for shock type was 1.37 (95% CI 0.68-2.74). After adjusting for potential confounders, the OR for shock type remained insignificant (1.33, 95% CI 0.60-2.53). We observed no significant difference in ROSC (54.7% versus 52.6%, absolute difference 2.1%, p= 0.87) or neurologically intact survival to hospital discharge (21.9% versus 33.3%, absolute difference 11.4%, p= 0.31) between those with and without VF recurrence. Conclusions: Presenting VF was terminated with one shock in 87.8% of cases. We observed no significant difference in the frequency of shock success between initial versus recurrent VF. VF recurred in the majority of patients and did not adversely affect shock success, ROSC, or survival.

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Defibrillation

KW - Emergency medical services

KW - Resuscitation

KW - Ventricular fibrillation

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