To Determine Optimal Time for Delivering Electrical Shocks to Cardiac Arrest Patients

Study Overview
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Brief Summary
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In this study, we are comparing the difference in outcomes between patients who were given shocks to the heart, during the upstroke of cardiopulmonary resuscitation (CPR) and before CPR is started. The study population will be all cardiac arrest patients attended by the staff of the Emergency Department who fulfil the eligibility criteria. Patients will be managed according to currently approved cardiac arrest protocols. Patients confirmed in cardiac arrest have manual chest compressions started while mechanical CPR (whereby chest compressions are delivered by an automated device) is prepared. Mechanical CPR should be started as soon as possible (<1 minute). If patients are eligible to be shocked, they will receive shocks either during upstroke of CPR or before CPR is started. Thus the purpose of this study is to answer the question whether are there improvement in survival between when shocks are given during upstroke and before CPR is started.

Detailed Description
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The purpose of this study will be to compare shock success during defibrillation synchronized with the upstroke of chest compression (peak upstroke), and precompression (control). This will be the world's first study to characterize the phase dependency of defibrillation during mechanical CPR in humans and to evaluate if optimal synchronized defibrillation can improve clinical outcomes. The null hypothesis would be that there is no difference in shock success during defibrillation synchronized with the upstroke of chest compression (peak upstroke), and precompression (control). We will conduct statistical comparisons for the primary and secondary outcomes between the arms of the study. The study population will be all cardiac arrest patients attended by the staff of the ED over the study period who fulfill the eligibility criteria. Patients will be managed according to currently approved cardiac arrest protocols. Patients confirmed in cardiac arrest with have manual chest compressions started while mechanical CPR is prepared. Mechanical CPR should be started as soon as possible (<1 minunte). If a shockable rhythm is present (VF/VT), patients will receive one of pre-randomized defibrillation protocols: Synchronised defibrillation at peak-upstroke Synchronised defibrillation at precompression Definition of outcomes Shock success is defined as the termination of Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (VT) and the establishment of organized rhythm within 60 seconds. An organized rhythm requires at least 2 QRS complexes separated by no more than 5 seconds. Survival to hospital discharge is defined as patient surviving the primary event and discharged from the hospital alive. Return of spontaneous circulation is defined as the presence of any palpable pulse, which is detected by manual palpation of a major artery. Survival to admission is defined as the admission to hospital without ongoing CPR or other artificial circulatory support.

Official Title
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A Multicenter Randomised Controlled Trial Comparing Shock Success With Synchronized Defibrillation (Compression Upstroke Versus Precompression) During Ongoing Mechanical Cardiopulmonary Resuscitation In The Emergency Department

Conditions
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Cardiac Event, Sudden Cardiac Death, Death, Ventricular Fibrillation, Ventricular Tachycardia

Intervention / Treatment
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* Device: Upstroke Compression Defibrillation
* Device: Precompression Defibrillation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cardiac Arrest patients who received eith CPR and/or defibrillation Ventricular Fibrillation or Pulseless Ventricular Tachycardia Exclusion Criteria: Patients pronounced dead without attempting CPR according to standard operating procedure and ILCOR guidelines Cardiac arrest obviously caused by major trauma Children below age 21 Patients who are pregnant

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Precompression<br>Control arm | Device: Precompression Defibrillation<br> <br> |
| Active Comparator: Upstroke Compression<br>Intervention arm | Device: Upstroke Compression Defibrillation<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| successful electrical conversion (shock success) | Termination of Ventricular Fibrillation (VF) or pulseless Ventricular Tachycardia (VT) and the establishment of organized rhythm within 60 seconds. An organized rhythm requires at least 2 QRS complexes separated by no more than 5 seconds. | establishment of organized rhythm within 60 seconds | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| termination of VF regardless of the resulting rhythm |  | at least 5 seconds after the shock | 
| Return of spontaneous circulation (ROSC) |  | at least 20 minutes | 
| Survival to hospital admission |  | at least 1 day | 
| Survival to hospital discharge |  | at least 1 day | 
| Functional survival outcomes assessed by the Glasgow Outcomes Score (CPC/OPC) |  | at least 1 day | 
| European Quality of Life in 5 Dimensions |  | at least 1 day |