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A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in‐hospital setting
Author(s) -
Davis Daniel,
Aguilar Steve A.,
Sell Rebecca,
Minokadeh Anush,
Husa Ruchika
Publication year - 2016
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2499
Subject(s) - defibrillation , ventricular fibrillation , medicine , cardiopulmonary resuscitation , cardiology , ventricular tachycardia , shock (circulatory) , return of spontaneous circulation , anesthesia , fibrillation , resuscitation , atrial fibrillation
BACKGROUND In cases of in‐hospital–witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) arrest, it is unclear whether cardiopulmonary resuscitation prior to defibrillation attempt or expedited stacked defibrillation attempt is superior. METHODS Retrospective, observational study of all admitted patients with continuous cardiac monitoring who suffered VF/VT arrest between July 2005 and June 2013. In the stacked shock period (2005–2008), institutional protocols advocated early defibrillation with administration of 3 stacked shocks with brief pauses between each single defibrillation attempt to confirm sustained VF/VT. During the initial chest compression period (2008–2011), the protocol was modified to perform a 2‐minute period of chest compressions prior to each defibrillation, including the initial. In the modified stack shock period (2011–2013), for a monitored arrest, defibrillation attempts were expedited with up to 3 successive shocks administered for persistent VF/VT. In unmonitored arrest, chest compressions and ventilations were initiated prior to defibrillation. The primary outcome measure was survival to hospital discharge. RESULTS Six hundred sixty‐one cardiopulmonary arrests were recorded during the study period, with 106 patients (16%) representing primary VF/VT. The incidence of VF/VT arrest did not vary significantly between the study periods ( P = 0.16) Survival to hospital discharge for all primary VF/VT arrest victims decreased, then increased significantly from the stacked shock period to initial chest compression period to modified stacked shock period (58%, 18%, 71%, respectively, P < 0.01). Specific group differences were significant between the initial chest compression versus the stacked and modified stacked shock groups (all P < 0.01). CONCLUSION Data suggest that monitored VF/VT should undergo expeditious defibrillation with use of stacked shocks. Journal of Hospital Medicine 2016;11:264–268. © 2015 Society of Hospital Medicine