Mr Benjamin STANTON1
1SA AMBULANCE SERVICE, ,
Abstract:
The purpose of the presentation
To describe a case of an out of hospital cardiac arrest (OOHCA) of a morbidly obese 22-year-old male patient who was successfully resuscitated by South Australian Ambulance Service (SAAS) and MedSTAR, with double sequential external defibrillation (DSED).
The nature and scope of the topic
Survival rates for OOHCA globally remains poor despite significant advances in defibrillator technology, public access to automated external defibrillators (AED’s) and improvements in pre-hospital advanced life support (ALS) training and its clinical application such as ‘high performance CPR’. In Australia there are around 20,000 OOHCA’s per year compared to the United States where there are 1000 OOHCA’s per day. Approximately one third of these cardiac arrests are either ventricular fibrillation or pulseless ventricular tachycardia (VF / pVT). These two rhythms require direct current (DC) from a defibrillator to improve survival. Of this cohort of patients where the cardiac rhythm is VF/pVT the survival rate is still around 30% but decreases significantly when the rhythm, is refractory or resistant to standard ALS and DC shock therapy.
The issue or problem under consideration
DSED is the novel use of two separate defibrillator devices that are attached to the patient via external pads and then discharged simultaneously, or in sequence, to hopefully terminate the refractory arrythmia. Issues such as the definition of refractory VF, the lack of consensus around the definition, the current literature and research around this novel procedure including the use of DSED and vector change (VC) therapy in the pre-hospital space will be discussed.
The outcome or the conclusion reached
DSED or VC practices are safe, feasible and effective however more research is needed as well as a standard definition of refractory VF. However, pre-hospital and retrieval clinicians should keep this clinical procedure in their ‘toolbox’.
Biographies:
Ben Stanton is a Nurse Practitioner specialising in aeromedical retrieval & transport, currently employed at South Australian Ambulance Service (SAAS) MedSTAR Emergency Medical Retrieval Service. He is passionate about the nurse’s role in the stabilisation, management and transportation of the critically ill medical and trauma patient, as well as clinical education and simulation training. He is a member of AUSMAT, the Australian Government’s emergency and disaster response capability for Australia and is an active specialist reserve member of the Royal Australian Air Force (RAAF) specialising in the transportation of the critically ill & injured.