Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Network Open, 7(9), e2431673. https://doi.org/10.1001/jamanetworkopen.2024.31673 Dr. Joshua R. Lupton et al.
Points
- This cohort study examined the impact of anterior-posterior (AP) versus anterior-lateral (AL) defibrillator pad placement on outcomes in 255 patients with shockable out-of-hospital cardiac arrest (OHCA).
- AP pad placement was significantly more effective in achieving the return of spontaneous circulation (ROSC) compared to AL placement (adjusted odds ratio, 2.64).
- There were no significant differences between AP and AL pad placement for pulses at emergency department arrival, survival to hospital admission, survival to discharge, or functional survival at discharge.
- AP pad placement was associated with a higher cumulative incidence of ROSC, indicating its potential benefit in early resuscitation.
- While AP pad placement improved ROSC, further research is necessary to understand its impact on long-term survival and neurological outcomes.
Summary
This cohort study investigated the impact of defibrillator pad placement—anterior-posterior (AP) versus anterior-lateral (AL)—on outcomes in patients presenting with shockable out-of-hospital cardiac arrest (OHCA). A total of 255 patients with ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) were treated by emergency medical services (EMS) over four years. The primary outcome was the return of spontaneous circulation (ROSC), with secondary outcomes including the presence of pulses upon emergency department (ED) arrival, survival to hospital admission, survival to discharge, and functional survival at discharge. The analysis used adjusted odds ratios (aOR) and multivariable logistic regression to account for confounding variables.
The results showed that patients with AP defibrillator pad placement had significantly better odds of achieving ROSC than those with AL placement (aOR, 2.64; 95% CI, 1.50-4.65). However, there were no significant differences between the two groups in terms of pulses present at ED arrival (aOR, 1.34; 95% CI, 0.78-2.30), survival to hospital admission (aOR, 1.41; 95% CI, 0.82-2.43), survival to discharge (aOR, 1.55; 95% CI, 0.83-2.90), or functional survival at discharge (aOR, 1.86; 95% CI, 0.98-3.51). Competing risk analysis revealed that AP pad placement was associated with a significantly higher cumulative incidence of ROSC (subdistribution hazard ratio, 1.81; 95% CI, 1.23-2.67; P = .003).
The findings suggest that AP pad placement may be more effective than AL in improving ROSC outcomes in patients with VF or pVT OHCA. However, other survival measures did not show significant differences. These results highlight the importance of considering AP pad positioning in initial resuscitation strategies for patients with shockable OHCA. Further research is needed to explore the broader implications for survival and neurological outcomes.
Link to the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823184
References Lupton, J. R., Newgard, C. D., Dennis, D., Nuttall, J., Sahni, R., Jui, J., Neth, M. R., & Daya, M. R. (2024). Initial defibrillator pad position and outcomes for shockable out-of-hospital cardiac arrest. JAMA Network Open, 7(9), e2431673. https://doi.org/10.1001/jamanetworkopen.2024.31673
