![]() ![]() ![]() First randomized control trial to compare the use of a second external defibrillator and pad placement change to standard therapy.Five patients were found to be in pulseless ventricular tachycardia, 2 in the standard arm, 2 in the VC arm and 1 in the DSED arm.450 patients were enrolled and a total of 405 underwent randomization.Good neurologic outcome, defined as a modified Rankin score of Return of spontaneous circulation (ROSC), defined as any change in rhythm to an organized rhythm with a corresponding palpable pulse and blood pressure.Termination of ventricular fibrillation on subsequent rhythm analysis after defibrillation and 2 minutes of CPR.Patients being treated by non-participating fire or EMS agencies who did not get three shocks.Cardiac arrest secondary to drowning, hypothermia, hanging or suspected drug overdose.Remaining in refractory VF or pulseless ventricular tachycardia after three standard defibrillation shocks.Non-traumatic OHCA of presumed cardiac etiology.Adult patients over the age of 18 years old.The trial was stopped early due to longer prehospital response times secondary to staffing shortages interfering with the timely delivery of the assigned defibrillation strategy.Meaning an intentional short delay of <1 second between the shocks was implemented (more on this in discussion section) To avoid possible defibrillator damage, double sequential and not simultaneous defibrillation was performed. ![]() Cluster crossing over meant that each of the paramedic services in the six regions was randomized to one of the three treatment approaches and then crossed over to an alternate defibrillation strategy every 6 months.Prehospital care was provided by “advanced care” paramedics who perform full ACLS and are assisted by “primary care” paramedics who perform basic life support skills with the addition of a small number of medications and manual defibrillation.Strategy 3: DSED with pads in the anterior-posterior position and an intentional delay to ensure rapid sequence delivery vs simultaneous defibrillation.Strategy 2: Vector change (VC) defibrillation with pads transferred from the standard anterior-lateral to the anterior-posterior position.Strategy 1: Continued standard defibrillation therapy with pads in the anterior-lateral configuration.One of the three following defibrillation strategies was assigned through computer-generated randomization to one of the six regional paramedic services and performed after three standard defibrillation attempts by either responding paramedics or participating fire services:.The study occurred from March 2018 to May 2022 with a pause from April 2020 to September 2020 to address concerns about paramedics performing aerosolizing procedures during the COVID-19 pandemic.Three-arm pilot randomized control trial with a randomized cluster crossing period, conducted across six paramedic services in Ontario, Canada. ![]()
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