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首页> 外文期刊>Canadian Journal of Emergency Medicine >PL02: Double Sequential External Defibrillation for Refractory Ventricular Fibrillation: the DOSE VF pilot randomized controlled trial
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PL02: Double Sequential External Defibrillation for Refractory Ventricular Fibrillation: the DOSE VF pilot randomized controlled trial

机译：PL02：难治性心室纤维化的双顺序外部除颤：剂量vf试点随机对照试验

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Introduction: Despite recent advances in resuscitation, some patients remain in ventricular fibrillation (VF) after multiple defibrillation attempts during out-of-hospital cardiac arrest (OHCA). Vector change defibrillation (VC) and double sequential external defibrillation (DSED) have been proposed as alternate therapeutic strategies for OHCA patients with refractory VF. The primary objective was to determine the feasibility, safety and sample size required for a future cluster randomized controlled trial (RCT) with crossover comparing VC or DSED to standard defibrillation for patients experiencing refractory VF. Secondary objectives were to evaluate the intervention effect on VF termination and return of spontaneous circulation (ROSC). Methods: We conducted a pilot cluster RCT with crossover in four Canadian paramedic services and included all treated adult OHCA patients who presented in VF and received a minimum of three defibrillation attempts. In addition to standard cardiac arrest care, each EMS service was randomly assigned to provide continued standard defibrillation (control), VC or DSED. Services crossed over to an alternate defibrillation strategy after six months. Prior to the launch of the trial, 2,500 paramedics received in-person training for VC and DSED defibrillation using a combination of didactic, video and simulated scenarios. Results: Between March 2018 and September 2019, 152 patients were enrolled. Monthly enrollment varied from 1.4 to 6.1 cases per service. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement or concerns expressed by paramedics, patients, families, or ED staff about the trial. In the standard defibrillation group, 66.6% of cases resulted in VF termination, compared to 82.0% in VC and 76.3% of cases in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Conclusion: Findings from our pilot RCT suggest the DOSE VF protocol is feasible and safe. VF termination and ROSC were higher with VC and DSED compared to standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact patient-centered, clinical outcomes.
机译：介绍：尽管最近的复苏进展，但在医院外心脏骤停（OHCA）的多种除颤试图后，一些患者仍然存在心室颤动（VF）。矢量改变除颤（VC）和双顺序外部除颤（DSED）被提出为OHCA耐火血管患者的替代治疗策略。主要目的是确定未来集群随机控制试验（RCT）的可行性，安全性和样本大小，通过对体验耐火vf的患者进行分组或DSED对标准除颤的交叉。次要目标是评估对VF终止和自发循环返回的干预效果（ROSC）。方法：我们通过四个加拿大护理服务的交叉进行了一台试验群体RCT，包括所有治疗的成人OHCA患者，他们介绍VF，并收到最少三次除颤试图。除了标准心脏骤停护理外，每个EMS服务都是随机分配的，以提供持续的标准除颤（对照），VC或DSED。六个月后，服务越过交替除颤策略。在推出试验之前，使用教学，视频和模拟场景的组合，2,500名护理人员接收了VC和DSED除颤的人员培训。结果：2018年3月至2019年9月，152名患者注册。每项服务的每月入学人数从1.4左右变化。关于可行性，89.5％的病例接受了它们随机分配的除颤策略，93.1％的病例在第六次除颤之前在第六次除颤之前接受VC或DSED休克。没有报告的除颤器发生故障，皮肤灼伤，难度难以与医护人员，患者，家庭或ED工作人员表达的垫子放置或疑虑。在标准除颤组中，66.6％的病例导致VF终止，而VC中的82.0％和76.3％的DSED组病例。 ROSC分别以25.0％，39.3％和40.0％的标准，VC和DSED组实现。结论：我们的试点RCT的调查结果表明剂量VF协议是可行和安全的。 VC终端和ROSC与标准除颤相比，VC和DSED较高。该试点试验的结果将允许我们通知多中心群体RCT与交叉来确定难熔VF的替代除颤策略可能会影响患者以患者为中心的临床结果。

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