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Effectiveness of alternative shock strategies for out-of-hospital cardiac arrest : a systematic review
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Pocock, Helen, Deakin, Charles D., Lall, Ranjit, Smith, Christopher Matthew and Perkins, Gavin D. (2022) Effectiveness of alternative shock strategies for out-of-hospital cardiac arrest : a systematic review. Resuscitation Plus, 10 . 100232. doi:10.1016/j.resplu.2022.100232 ISSN 2666-5204.
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WRAP-Effectiveness-alternative-shock-strategies-out-of-hospital-cardiac-arrest-review-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (699Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/j.resplu.2022.100232
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 (n = 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.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | |||||||||
| Library of Congress Subject Headings (LCSH): | Electric countershock, Ventricular fibrillation -- Treatment, Emergency medical services, Coronary heart disease, Cardiac arrest -- Treatment -- Case studies, CPR (First aid) | |||||||||
| Journal or Publication Title: | Resuscitation Plus | |||||||||
| Publisher: | Elsevier | |||||||||
| ISSN: | 2666-5204 | |||||||||
| Official Date: | June 2022 | |||||||||
| Dates: |
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| Volume: | 10 | |||||||||
| Article Number: | 100232 | |||||||||
| DOI: | 10.1016/j.resplu.2022.100232 | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 26 May 2022 | |||||||||
| Date of first compliant Open Access: | 26 May 2022 | |||||||||
| RIOXX Funder/Project Grant: |
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