Defibrillation Strategies for Refractory Ventricular Fibrillation

Cheskes, Sheldon; Verbeek, P. Richard; Drennan, Ian R.; McLeod, Shelley; Turner, Laura; Pinto, Ruxandra; Feldman, Michael J.; Davis, Matthew M.; Vaillancourt, Christian; Morrison, Laurie J.; Dorian, Paul; Scales, Damon C.

doi:10.1056/nejmoa2207304

Cited by 71 publications

(62 citation statements)

References 38 publications

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“…Although there are studies showing that DSED may be successful in the treatment of RVF, a well-designed, high-quality, multicenter randomized trial is needed to elucidate the efficacy and role of DSED in the treatment of refractory VF. In the recent Sheldon Cheskes study ( 25 ) of patients with refractory ventricular fibrillation, it was shown that patients who received DSED defibrillation were more likely to survive to hospital discharge than those who received standard defibrillation. The trial was terminated early because of operational challenges.…”

Section: Discussionmentioning

confidence: 99%

Double sequential external defibrillation versus standard defibrillation in refractory ventricular fibrillation: A systematic review and meta-analysis

He²,

Li³

et al. 2022

Front. Cardiovasc. Med.

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IntroductionDouble sequential external defibrillation (DSED) in cardiopulmonary resuscitation has shown different results in comparison with standard defibrillation in the treatment of refractory ventricular fibrillation (RVF). This review aims to compare the advantages of DSED with standard defibrillation in the treatment of refractory ventricular fibrillation.Materials and methodsPubMed, Embase, Web of Science, and Cochrane Library were searched from inception to May 1, 2022. Studies included adult patients who developed RVF. The study used random-effects and fixed-effects models for meta-analysis, which was reported by risk ratio (RR) with 95% confidence interval (CI), mean difference (MD), or standardized mean difference (SMD). The risk of bias in individual studies was assessed using the Robins-I tool for observational studies and the Cochrane Risk of Bias 2 (ROB-2) tool for clinical trials. Primary outcomes included the termination of RVF, prehospital return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and good neurological recovery. Secondary outcomes included age, total defibrillation attempts, emergency medical system arrival time, and dose of epinephrine and amiodarone used.ResultsIn this systematic review and meta-analysis, 10 studies containing 1347 patients with available data on treatment outcomes were included. The pooled estimate was (RR 1.03, 95% CI, 0.89 to 1.19; Z = 0.42, P = 0.678 > 0.05) for Termination of RVF, (RR 0.84, 95% CI, 0.63 to 1.11; Z = 1.23, P = 0.219 > 0.05) for ROSC, (RR 0.86, 95% CI, 0.69 to 1.06; Z = 1.4, P = 0.162 > 0.05) for survival to hospital admission, (RR 0.77, 95%CI, 0.52 to 1.15; Z = 1.26, P = 0.206 > 0.05) for survival to hospital discharge, (RR 0.65, 95%CI, 0.35 to 1.22; Z = 1.33, P = 0.184 > 0.05) for good neurologic recovery, (MD −1.01, 95%CI, −3.07 to 1.06; Z = 0.96, P = 0.34 > 0.05) for age, (MD 2.27, 95%CI, 1.80 to 2.73; Z = 9.50, P = 0.001 < 0.05) for total defibrillation attempts, (MD 1.10, 95%CI, −0.45 to 66; Z = 1.39, P = 0.16 > 0.05) for emergency medical system arrival time, (SMD 0.34, 95%CI, 0.17 to 0.50; Z = 4.04, P = 0.001 < 0.05) for epinephrine, and (SMD −0.30, 95%CI, −0.65 to −0.05; Z = 1.66, P = 0.1 > 0.05) for amiodarone.ConclusionWe discovered no differences between DSED and standard defibrillation in termination of RVF, prehospital return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, good neurological outcome, emergency medical system arrival time, and amiodarone doses in patients with RVF. There were some differences in the number of defibrillations and epinephrine doses utilized during resuscitation.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329354], identifier [CRD42022329354].

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Section: Discussionmentioning

confidence: 99%

Double sequential external defibrillation versus standard defibrillation in refractory ventricular fibrillation: A systematic review and meta-analysis

He²,

Li³

et al. 2022

Front. Cardiovasc. Med.

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“…DSED is more effective than VC defibrillation. (31 words) [ 8 ] Deferiprone in Parkinson’s Disease Multicenter, phase 2, randomized, double-blind on the treatment of Parkinson’s disease In participants with early Parkinson’s disease who had never received levodopa and in whom treatment with dopaminergic medications was not planned, deferiprone was associated with worse scores in measures of parkinsonism than those with placebo over a period of 36 weeks. Deferiprone was associated with worse scores on measures of parkinsonism and decreased nigrostriatal iron content compared to placebo in participants with early Parkinson’s disease who had never received levodopa.…”

Section: Scientific Writingmentioning

confidence: 99%

Evaluating the Feasibility of ChatGPT in Healthcare: An Analysis of Multiple Clinical and Research Scenarios

et al. 2023

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This paper aims to highlight the potential applications and limits of a large language model (LLM) in healthcare. ChatGPT is a recently developed LLM that was trained on a massive dataset of text for dialogue with users. Although AI-based language models like ChatGPT have demonstrated impressive capabilities, it is uncertain how well they will perform in real-world scenarios, particularly in fields such as medicine where high-level and complex thinking is necessary. Furthermore, while the use of ChatGPT in writing scientific articles and other scientific outputs may have potential benefits, important ethical concerns must also be addressed. Consequently, we investigated the feasibility of ChatGPT in clinical and research scenarios: (1) support of the clinical practice, (2) scientific production, (3) misuse in medicine and research, and (4) reasoning about public health topics. Results indicated that it is important to recognize and promote education on the appropriate use and potential pitfalls of AI-based LLMs in medicine.

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“…However, recent CPR guidelines have suggested that in the instance of refractory ventricular fibrillation (VF), a change in the pad position could have been considered [ 14 ]. Indeed, this assumption was not supported by any clear scientific evidence, till 2022 when the “Double Sequential External Defibrillation for Refractory Ventricular Fibrillation” (DOSE VF) trial [ 15 ] was published. In this trial, refractory VF, a common condition observed in approximately 20% of patients [ 16 ], was defined as VF or pulseless ventricular tachycardia that persisted after three standard defibrillation attempts.…”

Section: Results and Discussion Of 2022 Rctsmentioning

confidence: 99%

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

Penna

Magliocca

Merigo

et al. 2023

JCM

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Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.

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Defibrillation Strategies for Refractory Ventricular Fibrillation

Cited by 71 publications

References 38 publications

Double sequential external defibrillation versus standard defibrillation in refractory ventricular fibrillation: A systematic review and meta-analysis

Double sequential external defibrillation versus standard defibrillation in refractory ventricular fibrillation: A systematic review and meta-analysis

Evaluating the Feasibility of ChatGPT in Healthcare: An Analysis of Multiple Clinical and Research Scenarios

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

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