Document Detail

Recurrent ventricular fibrillation during advanced life support care of patients with prehospital cardiac arrest.
MedLine Citation:
PMID:  18556106     Owner:  NLM     Status:  MEDLINE    
AIM OF THE STUDY: The response of recurrent episodes of ventricular fibrillation (VF) to defibrillation shocks has not been systematically studied. We analyzed outcomes from countershocks delivered for VF during advanced life support (ALS) care of patients with out-of-hospital cardiac arrest. METHODS: Cohort of patients with prehospital cardiac arrest presenting with VF, treated by ALS ambulance staff following ERC Guidelines 2000. Biphasic defibrillators provided shocks increasing from 200 to 360J. Recorded signals were analyzed to determine, for each shock, if VF was terminated and if a sustained organized rhythm was restored within 60s. RESULTS: In 465 of the 467 patients enrolled, the initial VF episode was terminated within three shocks: 92%, 61%, and 83% responded to 200J first, 200J second and 360J third shocks, respectively. VF recurred in 48% of patients within 2min of the first episode, and in 74% sometime during prehospital care. In the 175 patients experiencing five or more VF episodes, single shock VF termination dropped from the first to the fifth episode (90-80%, p<0.001) without change in transthoracic impedance, yet the proportion returning to organized rhythms increased (11-42%, p<0.0001). CONCLUSIONS: Repeated refibrillation is common in patients with VF cardiac arrest. The likelihood of countershocks to terminate VF declines for repeated episodes of VF, yet shocks that terminate these episodes result increasingly in a sustained organized rhythm.
Rudolph W Koster; Robert G Walker; Fred W Chapman
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-16
Journal Detail:
Title:  Resuscitation     Volume:  78     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-04     Completed Date:  2009-01-27     Revised Date:  2009-08-25    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  252-7     Citation Subset:  IM    
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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MeSH Terms
Advanced Cardiac Life Support*
Electric Countershock*
Emergency Medical Services
Follow-Up Studies
Heart Arrest / etiology,  physiopathology,  therapy*
Middle Aged
Needs Assessment
Prospective Studies
Treatment Outcome
Ventricular Fibrillation / diagnosis,  physiopathology,  therapy*

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