EARLY DEFIBRILLATION BY EMERGENCY PHYSICIANS OR EMERGENCY MEDICAL TECHNICIANS - A CONTROLLED, PROSPECTIVE MULTICENTER STUDY

In a controlled, prospective multi-centre study, defibrillation by eme rgency medical technicians (EMTs) was compared with the current standa rd 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 d efibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of pa tients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitati on (CPR) by EMTs, and defibrillation by physicians; control group)? Me thods: 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 re cording, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scal e as well as Pittsburgh Cerebral and Overall Performance Categories. R esults: A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibril lation 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 re turn 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 adrenal in administered in the study group was lower (P < 0.05). No statistica lly significant differences were found concerning the neurologic long- term prognosis. Conclusions: In our study, EMT defibrillation was equa lly effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from co llapse to defibrillation and to ROSC, as well as in adrenalin doses, b y EMT-defibrillation, EMTs in Germany should defibrillate if they reac h a patient prior to an EP, provided they have received continuous med ical training and supervision.