DEFI 2005: a randomized controlled trial of the effect of automated external defibrillator cardiopulmonary resuscitation protocol on outcome from out-of-hospital cardiac arrest.
BACKGROUND
Using automated external defibrillators (AEDs) that implement the Guidelines 2000 resuscitation protocol constrains administration of cardiopulmonary resuscitation (CPR) to <50% of AED connection time. We tested a different AED protocol aimed at increasing the CPR administered to patients with out-of-hospital cardiac arrest.


RESULTS
In a randomized controlled trial, patients with out-of-hospital cardiac arrest requiring defibrillation were treated with 1 of 2 AED protocols. In the control protocol, based on Guidelines 2000, sequences of up to 3 stacked countershocks were delivered, with rhythm analyses initially and after the first and second shocks. The study protocol featured 1 minute of CPR before the first shock, shorter CPR interruptions before and after each shock, and no stacked shocks. The primary end point was survival to hospital admission. Of 5107 out-of-hospital cardiac arrest patients connected to an AED, 1238 required defibrillation, and 845 were included in the final analysis. Study patients (n=421) had shorter preshock pauses (9 versus 19 seconds; P<0.001), had shorter postshock pauses (11 versus 33 seconds; P<0.001), and received more CPR (61% versus 48%; P<0.001) and fewer shocks (2.5 versus 2.9; P<0.001) than control patients (n=424). Similar proportions survived to hospital admission (43.2% versus 42.7%; P=0.87), survived to hospital discharge (13.3% versus 10.6%; P=0.19), achieved return of spontaneous circulation before physician arrival (47.0% versus 48.6%; P=0.65), and survived to 1 year (P=0.77).


CONCLUSIONS
Following prompts from AEDs programmed with a protocol similar to Guidelines 2005, firefighters shortened pauses in CPR and improved overall hands-on time, but survival to hospital admission of patients with ventricular fibrillation out-of-hospital cardiac arrest did not improve. Clinical Trial Registration- http://www.clinicaltrials.gov. Unique identifier: NCT00139542.
Jost
Daniel
D
Service Medical d'Urgence, Brigade de Sapeurs-Pompiers Paris, 1 Place Jules Renard, 75017 Paris, France. daniel.jost@pompiersparis.fr
Degrange
Hervé
H
Verret
Catherine
C
Hersan
Olivier
O
Banville
Isabelle L
IL
Chapman
Fred W
FW
Lank
Paula
P
Petit
Jean Luc
JL
Fuilla
Claude
C
Migliani
René
R
Carpentier
Jean Pierre
JP
D001331:Automation; D001775:Blood Circulation / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000401:mortality; D047548:Defibrillators / Q000706:statistics & numerical data*; D004867:Equipment Design; D006323:Heart Arrest / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015999:Multivariate Analysis; D011336:Probability; D011897:Random Allocation; D018635:Rescue Work; D012984:Software; D016896:Treatment Outcome