TY - JOUR
T1 - Recurrent ventricular fibrillation
T2 - Experience with first responders prior to advanced life support interventions
AU - Telesz, Brian J.
AU - Hess, Erik P.
AU - Atkinson, Elizabeth
AU - White, Roger D.
N1 - Publisher Copyright:
© 2014 Elsevier Ireland Ltd.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Aim: Following defibrillation, ventricular fibrillation (VF) frequently recurs during out-of-hospital cardiac arrest (OHCA). Prior studies have reported conflicting results regarding its association with survival. The aim of this study was to examine the impact of recurrent VF in the presence of first responders before advanced life support (ALS) interventions. Methods: Electrocardiographic data from first responder automated external defibrillators (AEDs) were analyzed. A successful shock was defined as termination of VF for 5. s or longer. Recurrent VF was defined as any VF that occurred after a successful shock. The primary outcome was neurologically intact survival to hospital discharge (CPC 1-2). Results: 108 patients within our emergency system experienced a witnessed VF arrest. Of these, 73 (68%) had at least one recurrence of VF. Median time to recurrence of VF was 25. s [interquartile range (IQR) 11-66. s]. Median time in recurrent VF was 180. s (IQR 105-266. s). Survival was observed in 25 (71%) of patients with no recurrent VF and in 36 (49%) who had recurrence. Recurrent VF was associated with a lower odds of survival on univariate analysis (OR 0.39, 95% CI 0.16-0.92, p=. 0.0325). After adjusting for bystander CPR, gender and age, recurrent VF had a similar direction of effect but was no longer significantly associated with neurologically intact survival (OR 0.44, 95% CI 0.17-1.11, p=. 0.081). Conclusions: In the presence of first responders, VF recurred in 68% of patients. Recurrent VF was associated with a lower odds of survival, though its prognostic significance appeared to be blunted when considered in light of confounding variables. Recurrent VF may have significant survival implications, and further studies to assess its prognostic significance should be performed.
AB - Aim: Following defibrillation, ventricular fibrillation (VF) frequently recurs during out-of-hospital cardiac arrest (OHCA). Prior studies have reported conflicting results regarding its association with survival. The aim of this study was to examine the impact of recurrent VF in the presence of first responders before advanced life support (ALS) interventions. Methods: Electrocardiographic data from first responder automated external defibrillators (AEDs) were analyzed. A successful shock was defined as termination of VF for 5. s or longer. Recurrent VF was defined as any VF that occurred after a successful shock. The primary outcome was neurologically intact survival to hospital discharge (CPC 1-2). Results: 108 patients within our emergency system experienced a witnessed VF arrest. Of these, 73 (68%) had at least one recurrence of VF. Median time to recurrence of VF was 25. s [interquartile range (IQR) 11-66. s]. Median time in recurrent VF was 180. s (IQR 105-266. s). Survival was observed in 25 (71%) of patients with no recurrent VF and in 36 (49%) who had recurrence. Recurrent VF was associated with a lower odds of survival on univariate analysis (OR 0.39, 95% CI 0.16-0.92, p=. 0.0325). After adjusting for bystander CPR, gender and age, recurrent VF had a similar direction of effect but was no longer significantly associated with neurologically intact survival (OR 0.44, 95% CI 0.17-1.11, p=. 0.081). Conclusions: In the presence of first responders, VF recurred in 68% of patients. Recurrent VF was associated with a lower odds of survival, though its prognostic significance appeared to be blunted when considered in light of confounding variables. Recurrent VF may have significant survival implications, and further studies to assess its prognostic significance should be performed.
KW - Emergency medical services
KW - Out-of-hospital cardiac arrest
KW - Sudden cardiac death
KW - Ventricular fibrillation
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U2 - 10.1016/j.resuscitation.2014.10.010
DO - 10.1016/j.resuscitation.2014.10.010
M3 - Article
C2 - 25447428
AN - SCOPUS:84922769576
SN - 0300-9572
VL - 88
SP - 138
EP - 142
JO - Resuscitation
JF - Resuscitation
ER -