Sidebottom David B, Gleeson-Hammerton Thomas, Pike John, Watson Adam J R, Owen Peter, Jeffery David, Hannah Julian, Taylor Matthew, Raitt James, Plumb James
Department of Anaesthesia and Intensive Care, Södertälje Sjukhus, Stockholm, Sweden.
Isle of Wight NHS Trust Ambulance Service, St Mary's Hospital, Isle of Wight, United Kingdom.
Resusc Plus. 2025 Jun 18;25:101008. doi: 10.1016/j.resplu.2025.101008. eCollection 2025 Sep.
A number of novel treatment strategies have been proposed for managing persistent/refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT). This survey investigated current practices amongst UK Helicopter Emergency Medical Services (HEMS) in preparation for a clinical trial of esmolol for persistent VF/pVT.
This was a cross-sectional survey of the prehospital management of persistent VF/pVT by UK HEMS. A peer-reviewed, pre-piloted survey was distributed to all 21 UK HEMS in January 2025 via the National HEMS Research and Audit forum. The survey included the operationalised definitions of persistent VF/pVT and pharmacological/non-pharmacological management strategies used by services. The survey was distributed via Google Forms and analysed in R (v4.4).
Of UK HEMS services that attend medical cardiac arrests, 19/20 (95%) responded. A formal protocol for the management of persistent VF/pVT existed in 10/19 (53%) services, with 8/10 (80%) defining persistent/refractory as ≥ 3 failed shocks. Modification of adrenaline dosing from the standard treatment algorithm was performed in 9/19 (47.4%) services (de-emphasised in all cases). Esmolol administration as part of a persistent VF/pVT protocol was reported by 2/19 (11%) of services. Most services administered intravenous lidocaine (14/19) and/or magnesium (18/19) for persistent rhythms or at the clinician's discretion. All services permitted vector change defibrillation technique for persistent VF/pVT, with 6/19 (32%) services additionally permitting dual sequential defibrillation.
Treatment strategies for managing persistent VF/pVT vary widely between UK HEMS. Further data is required to support an evidence-based pharmacological approach to this cohort.
已提出多种用于处理持续性/难治性室颤（VF）和无脉性室性心动过速（pVT）的新型治疗策略。本次调查研究了英国直升机紧急医疗服务（HEMS）在准备进行艾司洛尔治疗持续性VF/pVT临床试验时的当前做法。
这是一项对英国HEMS对持续性VF/pVT进行院前管理的横断面调查。2025年1月，通过国家HEMS研究与审核论坛向英国所有21个HEMS分发了一份经过同行评审且预先试点的调查问卷。该调查包括持续性VF/pVT的操作性定义以及各服务机构所采用的药物/非药物管理策略。调查问卷通过谷歌表单分发，并在R（v4.4）中进行分析。
在参与医疗心脏骤停救治的英国HEMS服务机构中，19/20（95%）做出了回应。10/19（53%）的服务机构存在管理持续性VF/pVT的正式方案，其中8/10（80%）将持续性/难治性定义为≥3次电击失败。9/19（47.4%）的服务机构对标准治疗算法中的肾上腺素剂量进行了调整（在所有情况下均降低了其重要性）。19个服务机构中有2/19（11%）报告将艾司洛尔给药作为持续性VF/pVT方案的一部分。大多数服务机构针对持续性心律或根据临床医生的判断给予静脉注射利多卡因（14/19）和/或镁剂（18/19）。所有服务机构均允许对持续性VF/pVT采用向量改变除颤技术，19个服务机构中有6/19（32%）还允许双序列除颤。
英国HEMS之间处理持续性VF/pVT的治疗策略差异很大。需要更多数据来支持针对这一群体的循证药理学方法。
