BACKGROUND: Current resuscitation guidelines (2005 guidelines [G2005]) accelerate ventricular fibrillation (VF) recurrence. We investigated whether patients resuscitated under G2005 spend more time in VF and have better survival rates than patients treated under the 2000 guidelines (G2000). METHODS AND RESULTS: We analyzed continuous ECG recordings of out-of-hospital cardiac arrests prospectively collected from January 2006 to January 2008. Patients treated according to G2000 (n=282) or G2005 (n=240) with VF as initial rhythm were included. We measured the total time a patient was in recurrent VF (the sum of all intervals from each onset of recurrent VF to each next successful shock) and the time a patient was in initial VF (time interval from rescuer arrival to first effective shock). The primary outcome measure was neurologically intact survival to discharge. The median time in recurrent VF was 2.7 minutes (quartile 1 to 3, 0.4 to 9.0 minutes) under G2000 versus 4.0 minutes (quartile 1 to 3, 0.2 to 11.6 minutes) under G2005 (P=0.03). Median time in initial VF was 2.7 minutes (quartile 1 to 3, 1.7 to 4.3 minutes) versus 3.9 minutes (quartile 1 to 3, 2.3 to 6.5 minutes), respectively (P<0.001). Increased time in recurrent VF was significantly associated with decreased neurologically intact survival in both G2000 use (odds ratio, 0.92; 95% confidence interval, 0.87 to 0.97; P=0.001) and G2005 use (odds ratio, 0.94; 95% confidence interval, 0.90 to 0.99; P=0.02). Neurologically intact survival decreased significantly with increasing time in initial VF under G2000 (odds ratio, 0.86; 95% confidence interval, 0.74 to 0.99; P=0.04). This observation was nonexistent in patients treated under G2005. Neurologically intact survival was 29% (82 of 282) under G2000 versus 27% (65 of 240) under G2005 (P=0.61). CONCLUSIONS: With G2005, the time in recurrent VF remains associated with worse outcome. Studies of immediate defibrillation for recurrent VF are warranted.
BACKGROUND: Current resuscitation guidelines (2005 guidelines [G2005]) accelerate ventricular fibrillation (VF) recurrence. We investigated whether patients resuscitated under G2005 spend more time in VF and have better survival rates than patients treated under the 2000 guidelines (G2000). METHODS AND RESULTS: We analyzed continuous ECG recordings of out-of-hospital cardiac arrests prospectively collected from January 2006 to January 2008. Patients treated according to G2000 (n=282) or G2005 (n=240) with VF as initial rhythm were included. We measured the total time a patient was in recurrent VF (the sum of all intervals from each onset of recurrent VF to each next successful shock) and the time a patient was in initial VF (time interval from rescuer arrival to first effective shock). The primary outcome measure was neurologically intact survival to discharge. The median time in recurrent VF was 2.7 minutes (quartile 1 to 3, 0.4 to 9.0 minutes) under G2000 versus 4.0 minutes (quartile 1 to 3, 0.2 to 11.6 minutes) under G2005 (P=0.03). Median time in initial VF was 2.7 minutes (quartile 1 to 3, 1.7 to 4.3 minutes) versus 3.9 minutes (quartile 1 to 3, 2.3 to 6.5 minutes), respectively (P<0.001). Increased time in recurrent VF was significantly associated with decreased neurologically intact survival in both G2000 use (odds ratio, 0.92; 95% confidence interval, 0.87 to 0.97; P=0.001) and G2005 use (odds ratio, 0.94; 95% confidence interval, 0.90 to 0.99; P=0.02). Neurologically intact survival decreased significantly with increasing time in initial VF under G2000 (odds ratio, 0.86; 95% confidence interval, 0.74 to 0.99; P=0.04). This observation was nonexistent in patients treated under G2005. Neurologically intact survival was 29% (82 of 282) under G2000 versus 27% (65 of 240) under G2005 (P=0.61). CONCLUSIONS: With G2005, the time in recurrent VF remains associated with worse outcome. Studies of immediate defibrillation for recurrent VF are warranted.
Authors: Chun Yue Francis Lee; Venkataraman Anantharaman; Swee Han Lim; Yih Yng Ng; Tek Siong Chee; Chong Meng Seet; Marcus Eng Hock Ong Journal: Singapore Med J Date: 2017-07 Impact factor: 1.858
Authors: David D Salcido; Robert H Schmicker; Noah Kime; Jason E Buick; Sheldon Cheskes; Brian Grunau; Stephanie Zellner; Dana Zive; Tom P Aufderheide; Allison C Koller; Heather Herren; Jack Nuttall; Matthew L Sundermann; James J Menegazzi Journal: Resuscitation Date: 2018-05-24 Impact factor: 5.262
Authors: David D Salcido; Robert H Schmicker; Jason E Buick; Sheldon Cheskes; Brian Grunau; Peter Kudenchuk; Brian Leroux; Stephanie Zellner; Dana Zive; Tom P Aufderheide; Allison C Koller; Heather Herren; Jack Nuttall; Matthew L Sundermann; James J Menegazzi Journal: Resuscitation Date: 2017-04-06 Impact factor: 5.262
Authors: Joseph S Piktel; Yi Suen; Shalen Kouk; Danielle Maleski; Gary Pawlowski; Kenneth R Laurita; Lance D Wilson Journal: J Am Heart Assoc Date: 2021-05-03 Impact factor: 5.501
Authors: Andreea Maria Ursaru; Antoniu Octavian Petris; Irina Iuliana Costache; Ana Nicolae; Adrian Crisan; Nicolae Dan Tesloianu Journal: J Cardiovasc Dev Dis Date: 2022-04-16