Effectiveness of Alternative Shock Strategies for Out-of-hospital Cardiac Arrest: A Systematic Review

Overview

Journal Resusc Plus

Date 2022 May 23

PMID 35602465

Authors

Helen Pocock

Charles D Deakin

Ranjit Lall

Christopher M Smith

Gavin D Perkins

Affiliations

Soon will be listed here.

Abstract

Aim: To determine the optimal first-shock energy level for biphasic defibrillation and whether fixed or escalating protocols for subsequent shocks are most effective.

Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, the Web of Science and national and international trial registry databases for papers published from database inception to January 2022. We reviewed reference lists of key papers to identify additional references. The population included adults sustaining non traumatic out-of-hospital cardiac arrest subject to attempted defibrillation. Studies of internal or monophasic defibrillation and studies other than randomised controlled trials or prospective cohorts were excluded. Two reviewers assessed study relevance. Data extraction and risk of bias assessment, using the ROBINS-I tool, were conducted by one reviewer and checked by a second reviewer. Data underwent intention-to-treat analysis.

Results: We identified no studies evaluating first shock energy. Only one study ( = 738) comparing fixed versus escalating energy met eligibility criteria: a prospective cohort analysis of a randomised controlled trial of manual versus mechanical CPR. High fixed (360 J) energy was compared with an escalating (200-200/300-360 J) strategy. Researchers found 27.5% (70/255) of patients in the escalating energy group and 27.61% (132/478) in the fixed high energy group survived to hospital discharge (unadjusted risk ratio 0.99, 95% CI 0.73, 1.23). Results were of very low certainty as the study was at serious risk of bias.

Conclusion: This systematic review did not identify an optimal first-shock energy for biphasic defibrillation. We identified no survival advantage at 30 days when comparing 360 J fixed with 200 J escalating strategy.

Citing Articles

Defibrillation trials: POSED a challenge.

Nehme Z, Bray J Resusc Plus. 2024; 17:100586.

PMID: 38419830 PMC: 10900113. DOI: 10.1016/j.resplu.2024.100586.

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Pocock H, Deakin C, Lall R, Michelet F, Contreras A, Ainsworth-Smith M Resusc Plus. 2022; 12:100310.

PMID: 36238581 PMC: 9550652. DOI: 10.1016/j.resplu.2022.100310.

References

Rodriguez-Nunez A, Lopez-Herce J, Garcia C, Dominguez P, Carrillo A, Bellon J . Pediatric defibrillation after cardiac arrest: initial response and outcome. Crit Care. 2006; 10(4):R113. PMC: 1751019. DOI: 10.1186/cc5005. View

Haywood K, Whitehead L, Nadkarni V, Achana F, Beesems S, Bottiger B . COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation. 2018; 137(22):e783-e801. DOI: 10.1161/CIR.0000000000000562. View

Lavignasse D, Lemoine S, Menetre S, Didon J, Jost D, Jouven X . Improved survival to hospital discharge in paediatric in-hospital cardiac arrest using 2 Joules/kilogram as first defibrillation dose for initial pulseless ventricular arrhythmia. Resuscitation. 2020; 158:291-292. DOI: 10.1016/j.resuscitation.2020.09.042. View

Gutgesell H, Tacker W, Geddes L, Davis S, Lie J, McNamara D . Energy dose for ventricular defibrillation of children. Pediatrics. 1976; 58(6):898-901. View

Brown P, Brunnhuber K, Chalkidou K, Chalmers I, Clarke M, Fenton M . How to formulate research recommendations. BMJ. 2006; 333(7572):804-6. PMC: 1602035. DOI: 10.1136/bmj.38987.492014.94. View

Bossaert L, Koster R . Defibrillation: methods and strategies. A statement for the Advanced Life Support Working Party of the European Resuscitation Council. Resuscitation. 1992; 24(3):211-25. DOI: 10.1016/0300-9572(92)90181-b. View

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A . Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1):210. PMC: 5139140. DOI: 10.1186/s13643-016-0384-4. View

Van de Voorde P, Turner N, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D . European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021; 161:327-387. DOI: 10.1016/j.resuscitation.2021.02.015. View

Tibballs J, Kinney S . A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. Resuscitation. 2006; 71(3):310-8. DOI: 10.1016/j.resuscitation.2006.05.009. View

10.

Killingsworth C, Melnick S, Chapman F, Walker R, Smith W, Ideker R . Defibrillation threshold and cardiac responses using an external biphasic defibrillator with pediatric and adult adhesive patches in pediatric-sized piglets. Resuscitation. 2002; 55(2):177-85. DOI: 10.1016/s0300-9572(02)00157-0. View

11.

Zhou Z, Wang Y, Zhou H, Huang M, Liu H, Hsieh C . Defibrillation and resuscitation in a piglet model of pediatric ventricular fibrillation following AHA 2005 guidelines. Indian J Pediatr. 2010; 77(8):893-7. DOI: 10.1007/s12098-010-0128-8. View

12.

Walcott G, Melnick S, Killingsworth C, Ideker R . Comparison of low-energy versus high-energy biphasic defibrillation shocks following prolonged ventricular fibrillation. Prehosp Emerg Care. 2009; 14(1):62-70. PMC: 3276405. DOI: 10.3109/10903120903349838. View

13.

Blom M, Beesems S, Homma P, Zijlstra J, Hulleman M, van Hoeijen D . Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014; 130(21):1868-75. DOI: 10.1161/CIRCULATIONAHA.114.010905. View

14.

Deakin C . Dual sequential defibrillation: Hold your horses!. Resuscitation. 2020; 150:189-190. DOI: 10.1016/j.resuscitation.2020.03.001. View

15.

Soar J, Callaway C, Aibiki M, Bottiger B, Brooks S, Deakin C . Part 4: Advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2015; 95:e71-120. DOI: 10.1016/j.resuscitation.2015.07.042. View

16.

Bramer W, Rethlefsen M, Kleijnen J, Franco O . Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017; 6(1):245. PMC: 5718002. DOI: 10.1186/s13643-017-0644-y. View

17.

Carpenter J, Rea T, Murray J, Kudenchuk P, Eisenberg M . Defibrillation waveform and post-shock rhythm in out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation. 2003; 59(2):189-96. DOI: 10.1016/s0300-9572(03)00183-7. View

18.

Walker R, Koster R, Sun C, Moffat G, Barger J, Dodson P . Defibrillation probability and impedance change between shocks during resuscitation from out-of-hospital cardiac arrest. Resuscitation. 2009; 80(7):773-7. DOI: 10.1016/j.resuscitation.2009.04.002. View

19.

Moskowitz A, Holmberg M, Donnino M, Berg K . In-hospital cardiac arrest: are we overlooking a key distinction?. Curr Opin Crit Care. 2018; 24(3):151-157. PMC: 6007985. DOI: 10.1097/MCC.0000000000000505. View

20.

Deakin C, Nolan J, Sunde K, Koster R . European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation. 2010; 81(10):1293-304. DOI: 10.1016/j.resuscitation.2010.08.008. View