Cabañas José G, Myers J Brent, Williams Jefferson G, De Maio Valerie J, Bachman Michael W
Prehosp Emerg Care. 2015 January-March;19(1):126-130. doi: 10.3109/10903127.2014.942476. Epub 2014 Sep 22.
Abstract Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks. Current American Heart Association (AHA) guidelines acknowledge that the data are insufficient in determining the optimal pad placement, waveform, or energy level that produce the best conversion rates from OOHCA with VF. Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of refractory VF (RVF) during OOHCA resuscitation. Methods. A retrospective case series was performed in an urban/suburban emergency medical services (EMS) system with advanced life support care and a population of 900,000. Included were all adult OOHCAs having RVF during resuscitation efforts by EMS providers. RVF was defined as persistent VF following at least 5 unsuccessful single shocks, epinephrine administration, and a dose of antiarrhythmic medication. Once the patient was in RVF, EMS personnel applied a second set of pads and utilized a second defibrillator for single defibrillation with the new monitor/pad placement. If VF continued, EMS personnel then utilized the original and second monitor/defibrillator charged to maximum energy, and shocks were delivered from both machines simultaneously. Data were collected from electronic dispatch and patient care reports for descriptive analysis. Results. From 01/07/2008 to 12/31/2010, a total of 10 patients were treated with DSED. The median age was 76.5 (IQR: 65-82), with median resuscitation time of 51minutes (IQR: 45-62). The median number of single shocks was 6.5 (IQR: 6-11), with a median of 2 (IQR: 1-3) DSED shocks delivered. VF broke after DSED in 7 cases (70%). Only 3 patients (30%) had ROSC in the field, and none survived to discharge. Conclusion. This case series demonstrates that DSED may be a feasible technique as part of an aggressive treatment plan for RVF in the out-of-hospital setting. In this series, RVF was terminated 70% of the time, but no patient survived to discharge. Further research is needed to better understand the characteristics of and treatment strategies for RVF.
摘要 背景。心室颤动（VF）被认为是院外心脏骤停（OOHCA）时神经功能完好存活可能性最高的心律。不幸的是，有时VF对标准除颤电击无反应。美国心脏协会（AHA）当前指南承认，在确定能使OOHCA伴VF获得最佳转复率的最佳电极片放置位置、波形或能量水平方面，数据并不充分。目的。描述一种用于OOHCA复苏期间难治性VF（RVF）病例的双重序贯体外除颤（DSED）技术。方法。在一个拥有高级生命支持护理且人口为90万的城市/郊区紧急医疗服务（EMS）系统中进行了一项回顾性病例系列研究。纳入的是EMS提供者在复苏过程中出现RVF的所有成年OOHCA患者。RVF定义为在至少5次单次电击、给予肾上腺素和一剂抗心律失常药物后仍持续的VF。一旦患者出现RVF，EMS人员应用第二组电极片，并使用第二台除颤器以新的监测器/电极片放置方式进行单次除颤。如果VF持续，EMS人员随后使用充电至最大能量的原始和第二台监测器/除颤器，并同时从两台机器进行电击。从电子调度和患者护理报告中收集数据进行描述性分析。结果。从2008年7月1日至2010年12月31日，共有10例患者接受了DSED治疗。中位年龄为76.5（四分位间距：65 - 82），中位复苏时间为51分钟（四分位间距：45 - 62）。单次电击的中位次数为6.5（四分位间距：6 - 11），DSED电击的中位次数为2（四分位间距：1 - 3）。7例（70%）患者在DSED后VF终止。仅3例（30%）患者在现场恢复自主循环（ROSC），且无一例存活出院。结论。该病例系列表明，DSED可能是院外环境中RVF积极治疗计划一部分的可行技术。在本系列中，70%的时间里RVF得以终止，但无一例患者存活出院。需要进一步研究以更好地了解RVF的特征和治疗策略。
