[Defibrillation techniques in persistent ventricular fibrillation: which is the most effective?] / Defibrillatietechnieken bij aanhoudend ventrikelfibrilleren.

A recent study in NEJM (DOSE-VF) showed that administering two consecutive defibrillation shocks with two separate defibrillators improves outcomes for patients with out-of-hospital cardiac arrest (OHCA). This approach was used when a shockable rhythm persisted after three standard shocks, raising the question of new strategies to improve survival for patients with persistent ventricular fibrillation (VF). In the Netherlands, there are around 8,000 OHCA cases annually, with 49% attributed to shockable rhythms. Prompt defibrillation is crucial, but some patients do not respond effectively to it. They may experience rapid VF recurrence or refractory VF, both associated with reduced survival rates. The current European resuscitation protocol emphasizes high-quality chest compressions, early defibrillation, and addressing reversible causes. The DOSE-VF study demonstrated the effectiveness of double sequential external defibrillation (DSED) in improving survival, spontaneous circulation, and neurological outcomes. Techniques such as changing pad positions, increasing initial shock energy, and pad compression can enhance energy transfer. However, implementing double sequential shocks in practice is challenging, requiring two separate defibrillators. The limited effect of this intervention may not warrant changes to extensively trained resuscitation protocols.

EuReCa ONE - 27 Nations, ONE Europe, ONE Registry: a prospective observational analysis over one month in 27 resuscitation registries in Europe - the EuReCa ONE study protocol.

BACKGROUND: There is substantial variation in the incidence, likelihood of attempted resuscitation and outcomes from out-of-hospital cardiac arrest (OHCA) across Europe. A European, multi-centre study provides the opportunity to uncover differences throughout Europe and may help find explanations for these differences. Results may also have potential to support the development of quality benchmarking between European Emergency Medical Services (EMS). METHODS/DESIGN: This prospective European study involves 27 different countries. It provides a common Utstein-based dataset, data collection tool and a common data collection period for all participants. Study research questions will address the following: OHCA incidence in different European regions; incidence of cardiopulmonary resuscitation (CPR); initial presenting rhythm in patients where bystanders or EMS start CPR or any other resuscitation intervention; proportion of patients with any return of spontaneous circulation (ROSC); patient status at the end of pre-hospital treatment i.e. ROSC at handover to hospital, ongoing CPR, dead; proportion of patients still alive 30 days after OHCA; proportion of patients discharged alive from hospital. All patients who suffered an OHCA during October 2014 and were attended and/or treated by an EMS and documented in one of the participating registries will be included in the study. Each National Coordinator is responsible for data collection and quality control in his/her country and will transfer unprocessed anonymised data via secure electronic transfer. Descriptive analysis will be performed at European, national and registry level. For endpoints like ROSC, admission or survival, multivariate logistic regression analysis will be performed. DISCUSSION: Documenting differences in epidemiology, treatment and outcome in out-of-hospital cardiac arrest throughout Europe is a first step in finding explanations for these differences. Study results might also support the development of quality benchmarking between Emergency Medical Services (EMS) which in turn will facilitate initiatives to improve OHCA outcome in Europe. TRIAL REGISTRATION: The EuReCa ONE Study is registered by ClinicalTrials.gov National Coordinator T02236819 ).