Number of Prehospital Defibrillation Shocks and the Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest

The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

“…3,14,23,24 On the other hand, Jouffroy et al observed higher probabilities of prehospital ROSC than in the present study, perhaps explained by on-site prehospital ACLS provided by a specialized physician in that study. 13 Although not clearly associated with improved survival to hospital discharge, ACLS interventions (e.g., vasopressors and antiarrhythmics) have been shown to increase the rate of ROSC. 3,23,25 On the other hand, Hasegawa et al observed a slightly higher survival in their cohort compared to the present one, but only included patients with a witnessed collapse who are known to have a better prognosis.…”

“…On the contrary, in the studies of Hasegawa and Jouffroy, cut-offs of three and four shocks were proposed to predict survival and prehospital ROSC. 13,16 The absence of an obvious inflection point indicates that the arbitrary use of a specific cut-off is probably not sufficiently sensitive or specific to allow them to be used independently of other factors in clinical decisionmaking. The present results further our understanding of the prognostic implications of multiple shocks.…”

“…9 However, because of refractory (ventricular fibrillation not responding to the initial shocks) or recurrent (returning ventricular fibrillation after a period of non-shockable rhythm) arrhythmias, more than one shock is often required. [13][14][15][16] While the patients requiring more shocks may be expected to have worse outcomes, the precise prognostic implications of having a recurrent or refractory malignant arrhythmia remain uncertain, and many medical decisions, such as the timing of patient transport or the decision to cease resuscitation efforts, could be aided by more reliable early survival prognostication. This is especially true in prehospital settings with low rates of prehospital advanced cardiac life support (ACLS) for which this has not been described so far.…”

EuReCa_Serbia: How far we have progressed?

“…Navedeni podatak snažno sugeriše da je studija EuReCa Srbija pozitivno uticala na zaposlene u službama hitnih medicinskih pomoći te je organizovanijim pristupom uspela da se približi evropskim prosekom koji iznosi 22,2%. U pojedinim zemljama procenat inici-jalno šokabilnog ritma se beleži i do 49% (11). Uočljiv je porast trenda postizanja spontane cirkulacije (ROSC) sa 16% na 24% odn.…”

Survival of Out-of-Hospital Cardiac Arrest by Early Defibrillation in the Sorrento Peninsula

“…Choosing the best threshold value at 4, the delivery of < 4 shocks predicted survivors. Indeed there was a reduction of survival rate for > 4 schocks [33]. According to the AHA 2015 OHCA guidelines [31], a defibrillation shock can be delivered every 2 min and the following four shocks can be delivered with a delay of 8-10 min.…”