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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
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Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest.
Joshua R Lupton1, Craig D Newgard1, David Dennis2
1Department of Emergency Medicine, Oregon Health and Science University, Portland.
JAMA Network Open
|September 9, 2024
Summary
Anterior-posterior defibrillator pad placement in out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) was associated with higher return of spontaneous circulation (ROSC) compared to anterior-lateral placement.
Area of Science:
- Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) are primary causes of out-of-hospital cardiac arrest (OHCA).
- Defibrillator pad placement (anterior-posterior vs. anterior-lateral) is a critical factor in OHCA management, but its impact on patient outcomes remains unclear.
Purpose of the Study:
- To investigate the association between initial defibrillator pad placement position (anterior-posterior vs. anterior-lateral) and patient outcomes in OHCA cases presenting with VF or pVT.
Main Methods:
- A prospective cohort study was conducted involving 255 adult patients with OHCA and VF/pVT treated by a single North American EMS agency.
- Data were collected from July 2019 to June 2023, excluding pediatric patients, interfacility transfers, traumatic arrests, and those with DNR status.
- Outcomes included return of spontaneous circulation (ROSC), pulses at ED arrival, survival to admission and discharge, and functional survival, analyzed using multivariable logistic regression and competing risks regression.
Main Results:
- Patients with anterior-posterior (AP) pad placement (n=158) showed a significantly higher adjusted odds ratio for ROSC at any time compared to anterior-lateral (AL) placement (n=97) (aOR, 2.64).
- Competing risk analysis revealed a significantly greater cumulative incidence of ROSC with initial AP placement versus AL placement (SHR, 1.81; P=.003).
- No significant differences were observed in pulses at ED arrival, survival to hospital admission, survival to discharge, or functional survival between the two pad placement groups.
Conclusions:
- Anterior-posterior defibrillator pad placement in OHCA patients with VF or pVT is associated with a higher likelihood of achieving return of spontaneous circulation compared to anterior-lateral placement.
- While AP placement shows a benefit in ROSC, further research is needed to determine its impact on other critical patient outcomes such as survival to discharge and functional recovery.
