Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study

Abstract

In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany — defibrillation by emergency physicians (EPs) — in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians; control group)? Methods: Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recording, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories. Results: A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier ( P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier ( P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group ( P < 0.05). The total amount of adrenalin administered in the study group was lower ( P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis. Conclusions: In our study, EMT defibrillation was equally effective as defibrillation by EP's, but failed to improve survival or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.