Purpose
Management of cardiac arrest according to national and international guidelines has remained largely unchanged for a decade. Pre Hospital Critical Care teams such as Thames Valley Air Ambulance offer Critical Care Paramedic and Physician teams who respond to cardiac arrests and offer treatments beyond the scope of ambulance service clinicians. Following a review of cardiac arrests attended by TVAA and appraisal of evidence and current best practice we developed an additional algorithm for cases of adult medical cardiac arrest with refractory shockable rhythms. This adds to but does not replace the Advanced Life Support algorithm and includes the use of Anterior Posterior(AP) pad positioning and enhanced defibrillation strategies.
Method
Cases were analysed for the 3 months following the introduction of the algorithm (October 2021 - January 2022) and compared to the same period the year before.
Results
In the 3 months following the introduction of the algorithm in October 2021 TVAA attended 142 cardiac arrests (96 in the same period the previous year), 8 met the criteria for applying the refractory shockable rhythm algorithm, these cases received a median total of 12 shocks. In 4 out of 8 cases the refractory rhythm was terminated with 1 AP shock, in one case 2 shocks were required, in two cases 3 shocks were required and in one case care was withdrawn.
The rate of ROSC at hospital handover for the refractory shockable rhythms was 38% (17% in the previous year).
Conclusion
The enhanced algorithm has increased the rate of ROSC at hospital handover and resulted in termination of refractory shockable rhythms with 3 or fewer AP shocks. The outcomes are limited by the small study size. Wider dissemination of the techniques and a larger study are warranted.

An enhanced algorithm for refractory shockable rhythms terminates VF/VT and improves outcomes in out of hospital cardiac arrest.

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

On 16 and 17 June, we are organising our first-ever hybrid congress. You will be able to join us live at the beautiful conference venue in Antwerp, Belgium and present your Poster. 

We are happy to welcome you to Resuscitation 2022!