An evidence-based guideline of defibrillation for cardiac arrest patients

Abstract

Survival to discharge following a cardiac arrest is dependent on rapid and effective basic and advanced life support. As stated in the latest guideline of the American Heart Association (AHA, 2010), healthcare providers who treat cardiac arrest in hospital should use the defibrillator or other facilities with automated external defibrillators to provide immediate cardiopulmonary resuscitation.

Defibrillation plays an important role in restoring normal electrical rhythm and natural pacemaker control to the heart from chaotic heart rhythm such as ventricular fibrillation or pulseless ventricular tachycardia. This dissertation aims to identify the best evidence and develop an evidence-based guideline of defibrillation for cardiac arrest patients. The objectives of this thesis are to conduct a search of available literatures on defibrillation, mainly focusing on the defibrillation waveform and energy level, perform a critical appraisal on the literature, establish tables of evidence, and develop recommendations and defibrillation protocol for cardiac arrest patients.

A systematic search was performed using four electronic databases, including PubMed, Ovid Medicine, CINAHL and the journal Resuscitation. Six randomized controlled studies were selected from thousands of related studies which fulfilled the inclusion criteria of this dissertation. Data were extracted by tables of evidence and critical appraisal was performed. Also, the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) framework. By synthesizing the data from the six selected studies, the biphasic waveform with 200J as the first shock energy and 200J-300J-360J as subsequent shocks was shown to help to achieve more desirable clinical outcomes to cardiac patients. The implementation potential, including transferability, feasibility and cost/ benefit ratio of the innovation, was assessed, and the evidence-based practice protocol are beneficial for cardiac arrest patients. Also, a comprehensive implementation plan was demonstrated by discussing communication between different stakeholders and transitions the practice from initiation to guiding and sustaining stage. Pilot testing would be carried out to explore any unexpected technical and logistic issues that could be avoided in the full-scale implementation of the innovation. A full evaluation plan concerning patient outcomes, healthcare provider outcomes and system outcomes would then formulated and demonstrated in the end of this dissertation.