ArticleResuscitation plus2025
Management of persistent shockable rhythms during cardiac arrest: a national survey from the REVIVE group (REVIVE-2).
Article in Resuscitation plus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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10 authors.
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Abstract
Background: A number of novel treatment strategies have been proposed for managing persistent/refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT). This survey investigated current practices amongst UK Helicopter Emergency Medical Services (HEMS) in preparation for a clinical trial of esmolol for persistent VF/pVT. Method: This was a cross-sectional survey of the prehospital management of persistent VF/pVT by UK HEMS. A peer-reviewed, pre-piloted survey was distributed to all 21 UK HEMS in January 2025 via the National HEMS Research and Audit forum. The survey included the operationalised definitions of persistent VF/pVT and pharmacological/non-pharmacological management strategies used by services. The survey was distributed via Google Forms and analysed in R (v4.4). Results: Of UK HEMS services that attend medical cardiac arrests, 19/20 (95%) responded. A formal protocol for the management of persistent VF/pVT existed in 10/19 (53%) services, with 8/10 (80%) defining persistent/refractory as ≥ 3 failed shocks. Modification of adrenaline dosing from the standard treatment algorithm was performed in 9/19 (47.4%) services (de-emphasised in all cases). Esmolol administration as part of a persistent VF/pVT protocol was reported by 2/19 (11%) of services. Most services administered intravenous lidocaine (14/19) and/or magnesium (18/19) for persistent rhythms or at the clinician's discretion. All services permitted vector change defibrillation technique for persistent VF/pVT, with 6/19 (32%) services additionally permitting dual sequential defibrillation. Conclusion: Treatment strategies for managing persistent VF/pVT vary widely between UK HEMS. Further data is required to support an evidence-based pharmacological approach to this cohort.
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