Top

Trials

Published in:

Open Access 01-12-2008 | Study protocol

Automated external cardioversion defibrillation monitoring in cardiac arrest: a randomized trial

Authors: Bakhtiar Ali, Heather Bloom, Emir Veledar, Dorothy House, Robert Norvel, Samuel C Dudley, A Maziar Zafari

Published in: Trials | Issue 1/2008

Abstract

Background

In-hospital cardiac arrest has a poor prognosis despite active electrocardiography monitoring. The initial rhythm of approximately 25% of in-hospital cardiopulmonary resuscitation (CPR) events is pulseless ventricular tachycardia/ventricular fibrillation (VT/VF). Early defibrillation is an independent predictor of survival in CPR events caused by VT/VF. The automated external cardioverter defibrillator (AECD) is a device attached by pads to the chest wall that monitors, detects, and within seconds, automatically delivers electric countershock to an appropriate tachyarrhythmia.

Study Objectives

• To evaluate safety of AECD monitoring in hospitalized patients.

• To evaluate whether AECDs provide earlier defibrillation than hospital code teams.

Methods

The study is a prospective trial randomizing patients admitted to the telemetry ward to standard CPR (code team) or standard CPR plus AECD monitoring (PowerHeart CRM). The AECD is programmed to deliver one 150 J biphasic shock to patients in sustained VT/VF. Data is collected using the Utstein criteria for cardiac arrest. The primary endpoint is time-to-defibrillation; secondary outcomes include neurological status and survival to discharge, with 3-year follow-up.

Results

To date, 192 patients have been recruited in the time period between 10/10/2006 to 7/20/2007. A total of 3,655 hours of telemetry data have been analyzed in the AECD arm. The AECD has monitored ambulatory telemetry patients in sinus rhythm, sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, with premature ventricular complexes and non-sustained VT without delivery of inappropriate shocks. One patient experienced sustained VT during AECD monitoring, who was successfully defibrillated (17 seconds after meeting programmed criteria). There are no events to report in the control arm. The patient survived the event without neurological complications. During the same time period, mean time to shock for VT/VF cardiac arrest occurring outside the telemetry ward was 230 ± 50 seconds.

Conclusion

AECD monitoring is safe and likely results in earlier defibrillation than standard telemetry monitoring.

Trial Registration

National Institutes of Health registration ID: NCT00382928

Available only for authorised users

Chan PS, Krumholz HM, Nichol G, Nallamothu BK, American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators: Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med. 2008, 358: 9-17. 10.1056/NEJMoa0706467.CrossRefPubMed

Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME: Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the national registry of cardiopulmonary resuscitation. Resuscitation. 2003, 58: 297-308. 10.1016/S0300-9572(03)00215-6.CrossRefPubMed

Hazinski MF, Nadkarni VM, Hickey RW, O'Connor R, Becker LB, Zaritsky A: Editorial: major changes in the 2005 AHA Guidelines for CPR and ECC: reaching the tipping point for change. Circulation. 2005, 112 (suppl IV): IV-206-IV-211. 10.1161/CIRCULATIONAHA.105.170809.

Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP: Estimating effectiveness of cardiac arrest interventions. Circulation. 1997, 96: 3308-13.CrossRefPubMed

Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP: Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993, 22: 1652-8. 10.1016/S0196-0644(05)81302-2.CrossRefPubMed

Zafari AM, Zarter SK, Heggen V, Wilson P, Taylor RA, Reddy K: A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol. 2004, 44: 846-52. 10.1016/j.jacc.2004.04.054.CrossRefPubMed

Mattioni TA, Nademanee K, Brodsky M, Fisher J, Riggio D, Allen B: Initial clinical experience with a fully automatic in-hospital external cardioverter defibrillator. PACE. 1999, 22: 1648-55.CrossRefPubMed

Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F: Advances for treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol. 2003, 41: 627-32. 10.1016/S0735-1097(02)02865-6.CrossRefPubMed

Bento AM, Cardoso LF, Timerman S, Moretti MA, Peres ED, de Paiva EF: Preliminary in-hospital experience with a fully automatic external cardioverter-defibrillator. Resuscitation. 2004, 63: 11-6. 10.1016/j.resuscitation.2004.04.005.CrossRefPubMed

10.

Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG: Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000, 343: 1206-9. 10.1056/NEJM200010263431701.CrossRefPubMed

11.

Swedish Cardiac Arrest Registry: Factors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden. Eur Heart J. 2001, 22: 511-9. 10.1053/euhj.2000.2421.CrossRef

12.

White RD, Bunch TJ, Hankins DG: Evolution of a community-wide early defibrillation program experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation. 2005, 65: 279-83. 10.1016/j.resuscitation.2004.10.018.CrossRefPubMed

13.

Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM: Survival from in-hospital cardiac arrest during night and weekends. JAMA. 2008, 299: 785-92. 10.1001/jama.299.7.785.CrossRefPubMed

14.

Saxon LA: Survival after tachyarrhythmic arrest-what are we waiting for?. N Engl J Med. 2008, 358: 77-79. 10.1056/NEJMe0707823.CrossRefPubMed

Title: Automated external cardioversion defibrillation monitoring in cardiac arrest: a randomized trial
Authors: Bakhtiar Ali
Heather Bloom
Emir Veledar
Dorothy House
Robert Norvel
Samuel C Dudley
A Maziar Zafari
Publication date: 01-12-2008
Publisher: BioMed Central
Published in: Trials / Issue 1/2008
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/1745-6215-9-36

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Automated external cardioversion defibrillation monitoring in cardiac arrest: a randomized trial

Abstract

Background

Study Objectives

Methods

Results

Conclusion

Trial Registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Study Objectives

Methods

Results

Conclusion

Trial Registration

Please log in to get access to this content

Other articles of this Issue 1/2008

Bright light in elderly subjects with nonseasonal major depressive disorder: a double blind randomised clinical trial using early morning bright blue light comparing dim red light treatment

Randomised, crossover clinical trial, in healthy volunteers, to compare the systemic availability of two topical intranasal budesonide formulations

Rationale, design and methodology for a Prospective Randomized Study of graft patency in Off-pump and On-pump MultI-Vessel coronary artery bypasS Surgery (PROMISS) using multidetector computed tomography

Improving the outcomes of primary care attenders with common mental disorders in developing countries: a cluster randomized controlled trial of a collaborative stepped care intervention in Goa, India

Prospective controlled randomized trial on prevention of postoperative abdominal adhesions by Icodextrin 4% solution after laparotomic operation for small bowel obstruction caused by adherences [POPA study: Prevention of Postoperative Adhesions on behalf of the World Society of Emergency Surgery]

From multidimensional neuropsychological outcomes to a cognitive complication rate: The International Subarachnoid Aneurysm Trial