We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest.
- Authors
Lupton, Joshua R.; Newgard, Craig D.; Dennis, David; Nuttall, Jack; Sahni, Ritu; Jui, Jonathan; Neth, Matthew R.; Daya, Mohamud R.
- Abstract
Key Points: Question: What is the optimal initial defibrillator pad placement (anterior-posterior [AP] or anterior-lateral [AL]) for patients presenting with shockable out-of-hospital cardiac arrest (OHCA)? Findings: In this cohort study of 255 patients with shockable OHCA, patients with defibrillation pads placed AP had 2.64-fold greater odds of return of spontaneous circulation compared with patients with pads placed AL after adjustment for known confounders. Meaning: These findings suggest that AP placement may be superior to AL placement and clinicians should not assume equivalency of initial defibrillator pad positioning for patients with OHCA presenting with a shockable rhythm. This cohort study assesses the association between initial defibrillator pad placement position and out-of-hospital cardiac arrest among patients treated by emergency medical services in the United States. Importance: Ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) locations, impacts patient outcomes in VF or pVT OHCA. Objective: To determine the association between initial defibrillator pad placement position and OHCA outcomes for patients presenting with VF or pVT. Design, Setting, and Participants: This prospective cohort study included patients with OHCA and VF or pVT treated by a single North American emergency medical services (EMS) agency from July 1, 2019, through June 30, 2023. The study included patients with OHCA treated by a large suburban fire-based EMS agency that covers a population of 550 000. Consecutive patients with an initial EMS-assessed rhythm of VF or pVT receiving EMS defibrillation were included. Pediatric patients (younger than 18 years), interfacility transfers, arrests of obvious traumatic etiology, and patients with preexisting do-not-resuscitate status were excluded. Exposure: AP or AL pad placement. Main Outcomes and Measures: Return of spontaneous circulation (ROSC) at any time with secondary outcomes of pulses present at emergency department (ED) arrival, survival to hospital admission, survival to hospital discharge, and functional survival at hospital discharge (cerebral performance category score of 2 or less). Measures included adjusted odds ratios (aOR), multivariable logistic regressions, and Fine-Gray competing risks regression. Results: A total of 255 patients with OHCA were included (median [IQR] age, 66 [55-74] years; 63 females [24.7%]), with initial pad positioning documented as either AP (158 patients [62.0%]; median [IQR] age, 65 [54-74] years; 37 females [23.4%]) or AL (97 patients [38.0%]; median [IQR] age, 66 [57-74] years; 26 females [26.8%]). Patients with AP placement had higher adjusted odds ratio (aOR) of ROSC at any time (aOR, 2.64 [95% CI, 1.50-4.65]), but not significantly different odds of pulses present at ED arrival (1.34 [95% CI, 0.78-2.30]), survival to hospital admission (1.41 [0.82-2.43]), survival to hospital discharge (1.55 [95% CI, 0.83-2.90]), or functional survival at hospital discharge (1.86 [95% CI, 0.98-3.51]). Competing risk analysis found significantly greater cumulative incidence of ROSC among those at risk with initial AP placement compared with AL (subdistribution hazard ratio, 1.81 [95% CI, 1.23-2.67]; P =.003). Conclusions and Relevance: In this cohort study of patients with OHCA and VF or pVT, AP defibrillator pad placement was associated with higher ROSC compared with AL placement.
- Subjects
OREGON; VENTRICULAR fibrillation treatment; RESEARCH funding; PATIENTS; T-test (Statistics); HOSPITAL admission &; discharge; LOGISTIC regression analysis; DEFIBRILLATORS; TREATMENT effectiveness; VENTRICULAR fibrillation; EMERGENCY medical services; DISCHARGE planning; FUNCTIONAL status; DESCRIPTIVE statistics; CHI-squared test; VENTRICULAR tachycardia; LONGITUDINAL method; ODDS ratio; CARDIOPULMONARY resuscitation; CARDIAC arrest; PULSE (Heart beat); RETURN of spontaneous circulation; SURVIVAL analysis (Biometry); CONFIDENCE intervals; DATA analysis software
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2431673
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.31673