A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in‐hospital setting. Issue 4 (28th October 2015)

• Record Type: Journal Article
• Authors: Davis, Daniel; Aguilar, Steve A.; Sell, Rebecca; Minokadeh, Anush; Husa, Ruchika
• Is Part Of: Journal of hospital medicine. Volume 11:Issue 4(2016)
• Page Start: 264
• Page End: 268
• Publication Date: 2015-10-28
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2499
• Languages: English
• ISSNs: 1553-5592

Abstract

Abstract : BACKGROUND: In cases of in‐hospital–witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) arrest, it is unclear whether cardiopulmonary resuscitation prior to defibrillation attempt or expedited stacked defibrillation attempt is superior. METHODS: Retrospective, observational study of all admitted patients with continuous cardiac monitoring who suffered VF/VT arrest between July 2005 and June 2013. In the stacked shock period (2005–2008), institutional protocols advocated early defibrillation with administration of 3 stacked shocks with brief pauses between each single defibrillation attempt to confirm sustained VF/VT. During the initial chest compression period (2008–2011), the protocol was modified to perform a 2‐minute period of chest compressions prior to each defibrillation, including the initial. In the modified stack shock period (2011–2013), for a monitored arrest, defibrillation attempts were expedited with up to 3 successive shocks administered for persistent VF/VT. In unmonitored arrest, chest compressions and ventilations were initiated prior to defibrillation. The primary outcome measure was survival to hospital discharge. RESULTS: Six hundred sixty‐one cardiopulmonary arrests were recorded during the study period, with 106 patients (16%) representing primary VF/VT. The incidence of VF/VT arrest did not vary significantly between the study periods ( P = 0.16) Survival to hospital discharge for all primary VF/VT arrest victims decreased, then increased significantly from the stacked shock period to initial chest compression period to modified stacked shock period (58%, 18%, 71%, respectively, P < 0.01). Specific group differences were significant between the initial chest compression versus the stacked and modified stacked shock groups (all P < 0.01). CONCLUSION: Data suggest that monitored VF/VT should undergo expeditious defibrillation with use of stacked shocks. Journal of Hospital Medicine 2016;11:264–268. © 2015 Society of Hospital Medicine