Initial countershock in the treatment of asystole

Daniel R. Martin, Thomas Gavin, Joseph Bianco, Charles G. Browns, Harlan Stueven, Paul E. Pepe, Richard O. Cummins, Edgar Gonzalez, Michael Jastremski

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Routine provision of defibrillatory countershock (CS) in the initial management of asystolic cardiac arrest has been advocated because certain cases of ventricular fibrillation (VF) may present as asystole (AS). Objective: To determine the value of initial CS versus endotracheal intubation and pharmacologic therapy alone in the treatment of asystolic cardiac arrest. Design/Participants: A retrospective analysis of data collected prospectively during a multicenter study of out-of-hospital cardiac arrest. The study subjects were all patients whose initial cardiac arrest rhythm was AS and were treated with standard advanced cardiac life support (ACLS). Setting: Six urban emergency medical services (EMS) systems. Intervention: Patients in AS were treated initially with CS followed by ACLS therapy (CS Group), and were compared to those patients receiving endotracheal intubation and pharmacologic therapy alone (No CS Group). Outcome measures: Those receiving initial CS were compared to those not receiving CS using both Chi-square and logistic regression analysis. Outcome parameters included: rates of return of spontaneous circulation (ROSC), emergency department admission, hospital admission and hospital discharge. Results: Of the 194 patients presenting with AS, 77 received CS as their initial therapy. Of these, 13 (16.9%) had ROSC compared to 27 of the 117 (23.1%) from the No CS Group (P = 0.30). Emergency department and hospital admission rates were not significantly different; 13.0% versus 18.0% (P = 0.36), and 13.0% versus 11.1 % (P = 0.69) for CS versus No CS, respectively. None of the patients in the CS Group were discharged alive versus two (1.7%) from No CS (P = 0.52). Of 42 patients with bystander-witnessed cardiac arrests, 13.3% in the CS Group had ROSC compared to 40.7% in the No CS Group (P = 0.07). Emergency department admission rates were 6.7% for the CS Group and 33.3% for the No CS Group (P = 0.07); while hospital admission rates were 6.7% and 22.2%, respectively (P = 0.39). When these comparisons were adjusted for bystander-initiated CPR, CPR interval, and paramedic response interval, the P-values became 0.10, 0.05 and 0.17, respectively. Conclusions: Although, statistically, the results for both groups were not distinguishable, outcomes for asystolic patients had a tendency to be better when the initial therapy did not involve CS. Larger study populations are recommended to confirm these preliminary observations.

Original languageEnglish (US)
Pages (from-to)63-68
Number of pages6
JournalResuscitation
Volume26
Issue number1
DOIs
StatePublished - 1993

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Heart Arrest
Advanced Cardiac Life Support
Hospital Emergency Service
Intratracheal Intubation
Cardiopulmonary Resuscitation
Therapeutics
Out-of-Hospital Cardiac Arrest
Allied Health Personnel
Emergency Medical Services
Ventricular Fibrillation
Group Psychotherapy
Multicenter Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Population

Keywords

  • Asystole
  • Cardiac arrest
  • Cardiopulmonary resuscitation (CPR)
  • Countershock
  • Defibrillation
  • Epinephrine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Martin, D. R., Gavin, T., Bianco, J., Browns, C. G., Stueven, H., Pepe, P. E., ... Jastremski, M. (1993). Initial countershock in the treatment of asystole. Resuscitation, 26(1), 63-68. https://doi.org/10.1016/0300-9572(93)90164-L

Initial countershock in the treatment of asystole. / Martin, Daniel R.; Gavin, Thomas; Bianco, Joseph; Browns, Charles G.; Stueven, Harlan; Pepe, Paul E.; Cummins, Richard O.; Gonzalez, Edgar; Jastremski, Michael.

In: Resuscitation, Vol. 26, No. 1, 1993, p. 63-68.

Research output: Contribution to journalArticle

Martin, DR, Gavin, T, Bianco, J, Browns, CG, Stueven, H, Pepe, PE, Cummins, RO, Gonzalez, E & Jastremski, M 1993, 'Initial countershock in the treatment of asystole', Resuscitation, vol. 26, no. 1, pp. 63-68. https://doi.org/10.1016/0300-9572(93)90164-L
Martin DR, Gavin T, Bianco J, Browns CG, Stueven H, Pepe PE et al. Initial countershock in the treatment of asystole. Resuscitation. 1993;26(1):63-68. https://doi.org/10.1016/0300-9572(93)90164-L
Martin, Daniel R. ; Gavin, Thomas ; Bianco, Joseph ; Browns, Charles G. ; Stueven, Harlan ; Pepe, Paul E. ; Cummins, Richard O. ; Gonzalez, Edgar ; Jastremski, Michael. / Initial countershock in the treatment of asystole. In: Resuscitation. 1993 ; Vol. 26, No. 1. pp. 63-68.
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abstract = "Background: Routine provision of defibrillatory countershock (CS) in the initial management of asystolic cardiac arrest has been advocated because certain cases of ventricular fibrillation (VF) may present as asystole (AS). Objective: To determine the value of initial CS versus endotracheal intubation and pharmacologic therapy alone in the treatment of asystolic cardiac arrest. Design/Participants: A retrospective analysis of data collected prospectively during a multicenter study of out-of-hospital cardiac arrest. The study subjects were all patients whose initial cardiac arrest rhythm was AS and were treated with standard advanced cardiac life support (ACLS). Setting: Six urban emergency medical services (EMS) systems. Intervention: Patients in AS were treated initially with CS followed by ACLS therapy (CS Group), and were compared to those patients receiving endotracheal intubation and pharmacologic therapy alone (No CS Group). Outcome measures: Those receiving initial CS were compared to those not receiving CS using both Chi-square and logistic regression analysis. Outcome parameters included: rates of return of spontaneous circulation (ROSC), emergency department admission, hospital admission and hospital discharge. Results: Of the 194 patients presenting with AS, 77 received CS as their initial therapy. Of these, 13 (16.9{\%}) had ROSC compared to 27 of the 117 (23.1{\%}) from the No CS Group (P = 0.30). Emergency department and hospital admission rates were not significantly different; 13.0{\%} versus 18.0{\%} (P = 0.36), and 13.0{\%} versus 11.1 {\%} (P = 0.69) for CS versus No CS, respectively. None of the patients in the CS Group were discharged alive versus two (1.7{\%}) from No CS (P = 0.52). Of 42 patients with bystander-witnessed cardiac arrests, 13.3{\%} in the CS Group had ROSC compared to 40.7{\%} in the No CS Group (P = 0.07). Emergency department admission rates were 6.7{\%} for the CS Group and 33.3{\%} for the No CS Group (P = 0.07); while hospital admission rates were 6.7{\%} and 22.2{\%}, respectively (P = 0.39). When these comparisons were adjusted for bystander-initiated CPR, CPR interval, and paramedic response interval, the P-values became 0.10, 0.05 and 0.17, respectively. Conclusions: Although, statistically, the results for both groups were not distinguishable, outcomes for asystolic patients had a tendency to be better when the initial therapy did not involve CS. Larger study populations are recommended to confirm these preliminary observations.",
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AU - Martin, Daniel R.

AU - Gavin, Thomas

AU - Bianco, Joseph

AU - Browns, Charles G.

AU - Stueven, Harlan

AU - Pepe, Paul E.

AU - Cummins, Richard O.

AU - Gonzalez, Edgar

AU - Jastremski, Michael

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N2 - Background: Routine provision of defibrillatory countershock (CS) in the initial management of asystolic cardiac arrest has been advocated because certain cases of ventricular fibrillation (VF) may present as asystole (AS). Objective: To determine the value of initial CS versus endotracheal intubation and pharmacologic therapy alone in the treatment of asystolic cardiac arrest. Design/Participants: A retrospective analysis of data collected prospectively during a multicenter study of out-of-hospital cardiac arrest. The study subjects were all patients whose initial cardiac arrest rhythm was AS and were treated with standard advanced cardiac life support (ACLS). Setting: Six urban emergency medical services (EMS) systems. Intervention: Patients in AS were treated initially with CS followed by ACLS therapy (CS Group), and were compared to those patients receiving endotracheal intubation and pharmacologic therapy alone (No CS Group). Outcome measures: Those receiving initial CS were compared to those not receiving CS using both Chi-square and logistic regression analysis. Outcome parameters included: rates of return of spontaneous circulation (ROSC), emergency department admission, hospital admission and hospital discharge. Results: Of the 194 patients presenting with AS, 77 received CS as their initial therapy. Of these, 13 (16.9%) had ROSC compared to 27 of the 117 (23.1%) from the No CS Group (P = 0.30). Emergency department and hospital admission rates were not significantly different; 13.0% versus 18.0% (P = 0.36), and 13.0% versus 11.1 % (P = 0.69) for CS versus No CS, respectively. None of the patients in the CS Group were discharged alive versus two (1.7%) from No CS (P = 0.52). Of 42 patients with bystander-witnessed cardiac arrests, 13.3% in the CS Group had ROSC compared to 40.7% in the No CS Group (P = 0.07). Emergency department admission rates were 6.7% for the CS Group and 33.3% for the No CS Group (P = 0.07); while hospital admission rates were 6.7% and 22.2%, respectively (P = 0.39). When these comparisons were adjusted for bystander-initiated CPR, CPR interval, and paramedic response interval, the P-values became 0.10, 0.05 and 0.17, respectively. Conclusions: Although, statistically, the results for both groups were not distinguishable, outcomes for asystolic patients had a tendency to be better when the initial therapy did not involve CS. Larger study populations are recommended to confirm these preliminary observations.

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KW - Asystole

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation (CPR)

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KW - Defibrillation

KW - Epinephrine

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