{
    "abstract": "We explored the feasibility of a large-scale UK ambulance services trial of optimal defibrillation shock energy for out-of-hospital cardiac arrest. The primary objective of this feasibility study was to establish the number of eligible patients and the number recruited. Secondary outcomes were adherence to allocated treatment and data completeness.\nWe conducted a three-arm parallel group cluster randomised controlled feasibility study in a single ambulance service in southern England. Adult patients in out-of-hospital cardiac arrest treated for a shockable rhythm were included. Zoll\u00a0X\u00a0series defibrillators (clusters) were randomised to deliver 120-150-200\u00a0J, 150-200-200\u00a0J, or 200-200-200\u00a0J shock strategies.\nBetween March 2022 and February 2023, we randomised 38 eligible patients (120-150-200\u00a0J (n\u00a0=\u00a012), 150-200-200\u00a0J (n\u00a0=\u00a010), 200-200-200\u00a0J (n\u00a0=\u00a016)) to the study. The recruitment rate per cluster was 0.07 per month. The median patient age was 71\u00a0years (IQR 59-81\u00a0years); 79% were male. Twenty-eight cardiac arrests (74%) occurred in a private residence, 29 (76%) were witnessed and 32 (84%) patients received bystander CPR. Treatment adherence was 93% and completeness of clinical and electrical outcomes was 86%. At 30\u00a0days, 3/36 (8.3%) patients survived; we were unable to collect survival outcomes for two patients. Defibrillation data collection became difficult when defibrillators became separated from their allocated vehicles.\nWe have demonstrated the feasibility of a cluster randomised controlled trial of optimal shock energy for defibrillation in a UK ambulance service. We have identified possible solutions to issues relating to trial design.",
    "authors": [
        {
            "affiliation": "South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK.\nWarwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Helen",
            "initials": "H",
            "lastname": "Pocock"
        },
        {
            "affiliation": "South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK.\nUniversity Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, UK.",
            "firstname": "Charles D",
            "initials": "CD",
            "lastname": "Deakin"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Ranjit",
            "initials": "R",
            "lastname": "Lall"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Felix",
            "initials": "F",
            "lastname": "Michelet"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Chu",
            "initials": "C",
            "lastname": "Sun"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Deb",
            "initials": "D",
            "lastname": "Smith"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Catherine",
            "initials": "C",
            "lastname": "Hill"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Jeskaran",
            "initials": "J",
            "lastname": "Rai"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.",
            "firstname": "Kath",
            "initials": "K",
            "lastname": "Starr"
        },
        {
            "affiliation": "South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK.",
            "firstname": "Martina",
            "initials": "M",
            "lastname": "Brown"
        },
        {
            "affiliation": "South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK.",
            "firstname": "Isabel",
            "initials": "I",
            "lastname": "Rodriguez-Bachiller"
        },
        {
            "affiliation": "Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK.\nUniversity Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, Warwickshire, UK.",
            "firstname": "Gavin D",
            "initials": "GD",
            "lastname": "Perkins"
        }
    ],
    "conclusions": "We have demonstrated the feasibility of a cluster randomised controlled trial of optimal shock energy for defibrillation in a UK ambulance service. We have identified possible solutions to issues relating to trial design.",
    "copyrights": "\u00a9 2024 The Author(s).",
    "doi": "10.1016/j.resplu.2024.100569",
    "journal": "Resuscitation plus",
    "keywords": [
        "Cardiopulmonary Resuscitation",
        "Defibrillation",
        "Electric Countershock",
        "Feasibility study",
        "Out-of-hospital Cardiac Arrest",
        "Ventricular Fibrillation"
    ],
    "methods": null,
    "publication_date": "2024-02-19",
    "pubmed_id": "38370312\n32272235\n27810251\n33797430\n37024298\n28109996\n33773825\n26472860\n36238581\n27777223\n21350618\n22169081\n20351239\n15992986\n27565860\n11023932\n14656837\n17060379\n25467566",
    "results": "Between March 2022 and February 2023, we randomised 38 eligible patients (120-150-200\u00a0J (n\u00a0=\u00a012), 150-200-200\u00a0J (n\u00a0=\u00a010), 200-200-200\u00a0J (n\u00a0=\u00a016)) to the study. The recruitment rate per cluster was 0.07 per month. The median patient age was 71\u00a0years (IQR 59-81\u00a0years); 79% were male. Twenty-eight cardiac arrests (74%) occurred in a private residence, 29 (76%) were witnessed and 32 (84%) patients received bystander CPR. Treatment adherence was 93% and completeness of clinical and electrical outcomes was 86%. At 30\u00a0days, 3/36 (8.3%) patients survived; we were unable to collect survival outcomes for two patients. Defibrillation data collection became difficult when defibrillators became separated from their allocated vehicles.",
    "title": "Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial.",
    "xml": "<Element 'PubmedArticle' at 0x7885057ab920>"
}