Beyond the heart: neurological outcomes after multiple defibrillations

A study looked at how the number of defibrillations relates to neurological functions one month post-resuscitation.

Overview of the consequences of defibrillation

Non-medical resuscitation: what is the main objective?

When cardiac and circulatory emergencies requiring resuscitation occur outside of hospital, resuscitation measures are often primarily carried out by non-medical helpers, such as passers-by or ambulance staff. Due to the increasing availability of external defibrillators in everyday life, more and more cardiac arrests requiring defibrillation are being treated quickly. The most important goal is still the rapid restoration of spontaneous circulation. To achieve this, several shocks are sometimes necessary.

What about the administration of adrenaline?

The administration of adrenaline also plays an important role here. This drug is available in the emergency services and catecholamine is often administered at the latest when the emergency doctor arrives. It has been known for some time that the drug increases the chances of spontaneous circulatory activity.

Neurological outcomes

In addition to restoring the heart's pumping function, concerns about neurological functionality after resuscitation also play an important role in the everyday life of emergency physicians. A Japanese study investigated whether there is a correlation between neurological outcomes and the number of pre-hospital defibrillation attempts. Data from over 81,000 people with corresponding cardiovascular arrests was analysed. 

The research found that the more shocks, the worse the probability of good brain function one month after resuscitation. 

The surprising thing here is that if only the data of those people who received adrenaline in addition to defibrillation is analysed, it becomes clear that a higher number of electric shocks is associated with better neurological outcomes.

Adrenaline in practice

The data suggest that a higher number of defibrillations in out-of-hospital cardiac arrests was associated with poorer neurological survival. However, when shocks are combined with adrenaline, more defibrillations are associated with better outcomes.

  1. Tateishi K, Saito Y, Kitahara H, Shiko Y, Kawasaki Y, Nonogi H, Tahara Y, Yonemoto N, Nagao K, Ikeda T, Sato N, Kobayashi Y; Japanese Circulation Society Resuscitation Science Study JCS-ReSS Group. Impact of number of defibrillation attempts on neurologically favourable survival rate in patients with Out-of-Hospital cardiac arrest. Resuscitation. 2023 May;186:109779. doi: 10.1016/j.resuscitation.2023.109779. Epub 2023 Mar 22. PMID: 36963560.