Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial
Background: We explored the feasibility of a large-scale UK ambulance services trial of optimal defibrillation shock energy for out-of-hospital cardiac arrest. The primary objective of this feasibility study was to establish the number of eligible patients and the number recruited. Secondary outcome...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Resuscitation Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520424000201 |
| _version_ | 1827307817335259136 |
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| author | Helen Pocock Charles D Deakin Ranjit Lall Felix Michelet Chu Sun Deb Smith Catherine Hill Jeskaran Rai Kath Starr Martina Brown Isabel Rodriguez-Bachiller Gavin D. Perkins |
| author_facet | Helen Pocock Charles D Deakin Ranjit Lall Felix Michelet Chu Sun Deb Smith Catherine Hill Jeskaran Rai Kath Starr Martina Brown Isabel Rodriguez-Bachiller Gavin D. Perkins |
| author_sort | Helen Pocock |
| collection | DOAJ |
| description | Background: We explored the feasibility of a large-scale UK ambulance services trial of optimal defibrillation shock energy for out-of-hospital cardiac arrest. The primary objective of this feasibility study was to establish the number of eligible patients and the number recruited. Secondary outcomes were adherence to allocated treatment and data completeness. Methods: We conducted a three-arm parallel group cluster randomised controlled feasibility study in a single ambulance service in southern England. Adult patients in out-of-hospital cardiac arrest treated for a shockable rhythm were included. Zoll X series defibrillators (clusters) were randomised to deliver 120–150–200 J, 150–200–200 J, or 200–200–200 J shock strategies. Results: Between March 2022 and February 2023, we randomised 38 eligible patients (120–150–200 J (n = 12), 150–200–200 J (n = 10), 200–200–200 J (n = 16)) to the study. The recruitment rate per cluster was 0.07 per month. The median patient age was 71 years (IQR 59–81 years); 79% were male. Twenty-eight cardiac arrests (74%) occurred in a private residence, 29 (76%) were witnessed and 32 (84%) patients received bystander CPR. Treatment adherence was 93% and completeness of clinical and electrical outcomes was 86%. At 30 days, 3/36 (8.3%) patients survived; we were unable to collect survival outcomes for two patients. Defibrillation data collection became difficult when defibrillators became separated from their allocated vehicles. Conclusion: We have demonstrated the feasibility of a cluster randomised controlled trial of optimal shock energy for defibrillation in a UK ambulance service. We have identified possible solutions to issues relating to trial design. |
| first_indexed | 2024-03-08T03:29:01Z |
| format | Article |
| id | doaj.art-1687646b8d584b819f692f6fe574d1a6 |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-04-24T18:47:02Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-1687646b8d584b819f692f6fe574d1a62024-03-27T04:53:07ZengElsevierResuscitation Plus2666-52042024-03-0117100569Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trialHelen Pocock0Charles D Deakin1Ranjit Lall2Felix Michelet3Chu Sun4Deb Smith5Catherine Hill6Jeskaran Rai7Kath Starr8Martina Brown9Isabel Rodriguez-Bachiller10Gavin D. Perkins11South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK; Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK; Corresponding author at: Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK.South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK; University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UKSouth Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UKSouth Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UKWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK; University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, Warwickshire, UKBackground: We explored the feasibility of a large-scale UK ambulance services trial of optimal defibrillation shock energy for out-of-hospital cardiac arrest. The primary objective of this feasibility study was to establish the number of eligible patients and the number recruited. Secondary outcomes were adherence to allocated treatment and data completeness. Methods: We conducted a three-arm parallel group cluster randomised controlled feasibility study in a single ambulance service in southern England. Adult patients in out-of-hospital cardiac arrest treated for a shockable rhythm were included. Zoll X series defibrillators (clusters) were randomised to deliver 120–150–200 J, 150–200–200 J, or 200–200–200 J shock strategies. Results: Between March 2022 and February 2023, we randomised 38 eligible patients (120–150–200 J (n = 12), 150–200–200 J (n = 10), 200–200–200 J (n = 16)) to the study. The recruitment rate per cluster was 0.07 per month. The median patient age was 71 years (IQR 59–81 years); 79% were male. Twenty-eight cardiac arrests (74%) occurred in a private residence, 29 (76%) were witnessed and 32 (84%) patients received bystander CPR. Treatment adherence was 93% and completeness of clinical and electrical outcomes was 86%. At 30 days, 3/36 (8.3%) patients survived; we were unable to collect survival outcomes for two patients. Defibrillation data collection became difficult when defibrillators became separated from their allocated vehicles. Conclusion: We have demonstrated the feasibility of a cluster randomised controlled trial of optimal shock energy for defibrillation in a UK ambulance service. We have identified possible solutions to issues relating to trial design.http://www.sciencedirect.com/science/article/pii/S2666520424000201DefibrillationOut-of-hospital Cardiac ArrestVentricular FibrillationElectric CountershockCardiopulmonary ResuscitationFeasibility study |
| spellingShingle | Helen Pocock Charles D Deakin Ranjit Lall Felix Michelet Chu Sun Deb Smith Catherine Hill Jeskaran Rai Kath Starr Martina Brown Isabel Rodriguez-Bachiller Gavin D. Perkins Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial Resuscitation Plus Defibrillation Out-of-hospital Cardiac Arrest Ventricular Fibrillation Electric Countershock Cardiopulmonary Resuscitation Feasibility study |
| title | Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial |
| title_full | Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial |
| title_fullStr | Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial |
| title_full_unstemmed | Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial |
| title_short | Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial |
| title_sort | prehospital optimal shock energy for defibrillation posed a cluster randomised controlled feasibility trial |
| topic | Defibrillation Out-of-hospital Cardiac Arrest Ventricular Fibrillation Electric Countershock Cardiopulmonary Resuscitation Feasibility study |
| url | http://www.sciencedirect.com/science/article/pii/S2666520424000201 |
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