One-shock versus three-shock defibrillation protocol significantly improves outcome in a porcine model of prolonged ventricular fibrillation cardiac arrest

Article

关键词: CARDIOPULMONARY-RESUSCITATION;    CHEST COMPRESSIONS;    PRECORDIAL COMPRESSION;    RAPID DEFIBRILLATION;    WAVE-FORM;   

DOI  :  10.1161/CIRCULATIONAHA.105.592121

来源: SCIE

【 摘 要 】

Background - The success of resuscitation with a 1-shock versus the conventional 3-shock defibrillation protocol was investigated subject to the range of treatment variation imposed by automated external defibrillators ( AEDs). Methods and Results - Ventricular fibrillation was induced in 44 domestic pigs. After 7 minutes of untreated VF, animals were randomized among 4 groups representing all combinations of the 1-versus 3-shock protocol and 2 different AED regimens ( AED1, AED2). Because few AEDs support a 1-shock protocol, manual defibrillators were used to replicate the AED treatment regimen: electrical waveform, dose sequence, and cardiopulmonary resuscitation ( CPR) interruption intervals. Initial shock( s) were delivered, followed by 60 seconds of CPR, and the treatment was repeated until resuscitation was successful or for 15 minutes. The 1-shock protocol was associated with improved outcome, reducing CPR interruptions from 45% to 34% of total resuscitation time ( P = 0.019) and increasing survival from 64% to 100% ( P = 0.004). Survival was 91% for AED1 versus 36% for AED2 ( P = 0.024) with a 3-shock protocol but was increased to 100% for both by adoption of a 1-shock protocol. Improvements in postresuscitation left ventricular ejection fraction and stroke volume were observed with AED1 compared with AED2 ( difference of means, 15% and 28% of baseline respectively, P < 0.001) regardless of defibrillation protocol. Conclusions - Adoption of a 1-shock versus a 3-shock resuscitation protocol improved survival and minimized outcome differences imposed by variations in AED design and implementation. When a conventional 3-shock defibrillation protocol was used, however, the choice of AED had a significant impact on resuscitation outcome.

【 授权许可】

Free