Q&A
Before participating in the study, each ambulance organization has received training and practice in A-CPR with double defibrillation. Here, we have gathered the questions that arose during this training, so you can easily find the answers and share them if anyone has questions. If you'd like to know more, don't hesitate to contact us! info@doubled-trial.org
Q: If there is a public defibrillator or emergency services with a defibrillator on site, can we combine these and perform double defibrillation?
A: A: No, only the combination of Corpuls3 + Corpuls3 in manual mode is allowed for double defibrillation. This is because the safety of other combinations has not been evaluated by the manufacturers.
Q: Does it matter which defibrillator is used first in double defibrillation?
A: Strive to begin with the defibrillator connected in the standard position (antero-lateral).
Q: What grip should be used when pressing the button during double defibrillation (one finger or thumb grip)?
A: The most important thing is not to press both defibrillators exactly simultaneously, but with as short a time gap as possible (less than 1 second). The easiest approach is for one person to handle both defibrillators, using one hand for each defibrillator.
Q: How should the adhesive electrodes be placed if the patient has an ICD/pacemaker?
A: The presence of an ICD/pacemaker is not a barrier to defibrillation or participation in the study. Place the electrodes as usual, but ensure that no adhesive electrode is directly over the pacemaker. The nearest electrode should be at least 8 cm away from the pacemaker.
Q: For how long should double defibrillation continue?
A: Continue double defibrillation until the patient achieves ROSC, CPR is discontinued, or a decision is made to transport the patient while CPR is ongoing. If a decision is made to transport the patient, aim to perform 3 double defibrillations on-site before transport under ongoing CPR to the hospital (this decision is based on standard procedures and considerations). If practically possible, double defibrillation can be performed during transport. Otherwise, standard defibrillation with one defibrillator will be used during transport to the hospital.
Q: If the patient has been double defibrillated, achieves ROSC, but then goes into another ventricular fibrillation, should double defibrillation be performed again?
A: Yes! Keep all four electrodes in place until the patient is stabilized for transport. If new ventricular fibrillation occurs, perform double defibrillation.
Q: What should be done after completing a mission with double defibrillation?
A: After completing the mission, regardless of inclusion group/randomization outcome, that is, regardless of whether the patient was randomized to double defibrillation or standard treatment:
1. Scan the QR code on the inclusion cards for the study and fill in the details; both Rakel numbers should be registered.
2. Fill in the cardiac arrest information in Ambulink as accurately as possible.
After completing the mission, if double defibrillation has been performed:
3. Perform a functionality test on the defibrillator by turning it off and on – this will initiate an automatic self-test.
4. Test the defibrillation function by performing a test defibrillation with a test box. This should be done as soon as possible, but no later than during the shift change.
Q: What should we do if we arrive at a cardiac arrest together with an ambulance from, for example, Borås (which is not part of the study) as the second vehicle?
A: A: If it is "your" patient and you are responsible for the call, the patient can be included. However, if the situation is reversed – meaning you are supporting another ambulance outside your area that is not part of the study – the patient cannot be included at this time.
Q: How and when has information been communicated to emergency departments and nearby ambulance areas? What does it consist of?
A: All receiving hospitals have been provided with information before the study started in the form of an informational letter. Remember that DOUBLE-D is a prehospital study; once the patient has been handed over to the hospital, the intervention is concluded, and the hospital continues treatment according to standard procedures and guidelines.
Q: How long does it actually take to apply 2 electrode pairs, for example, on a large person with a hairy chest and back?
A: There are studies that show it takes about 12-15 seconds longer than just applying one electrode pair. If you coordinate the application during a breathing pause, it is possible to apply the back electrode in less than ten seconds in our scenario exercises. However, how long it actually takes in real-life situations is one of the things we hope the study will answer.
Q: How should the second pair of electrodes be applied during ongoing LUCAS-CPR?
A: One suggestion is to turn off the LUCAS, but NOT remove it. Then, tilt the patient 30-45 degrees, keeping the suction cup on the patient, and attach the back electrode (posterior). Turn the patient back and check that the suction cup is correctly positioned. Restart the LUCAS and then attach the second anterior plate.
Q: How many randomization envelopes are placed per ambulance and where are they located?
A: Each ambulance will have 2 randomization envelopes placed with the adhesive electrodes for the defibrillator. If one envelope has been used, notify your nearest supervisor or local study coordinator, and a new envelope will be provided as soon as possible!
Q: What will happen with the Corpuls1, how should we train with it, when will it arrive, where should it be placed in the ambulance, and how should it be secured during transport (if continued/extended double defibrillation in the ambulance)?
A: Currently, we only have the Corpuls3 available, and it is the only one to be used in the study.
Q: What do we do with other defibrillators, such as semi-automatics in gyms, etc?
A: First, always switch from AED to Corpuls3 with your electrodes. If the patient has been defibrillated with an AED, the patient can still be included, but double defibrillation can currently only be performed with 2 Corpuls3 manual defibrillators.
Q: Informed consent for study participation – when does it occur, does anything need to be said on site?
A: Informed consent is obtained from individuals who regain the ability to process information. We have ethical approval to conduct the study in this manner. There is already a weak recommendation from ILCOR regarding performing DSD, and it does not need to be explained or confirmed on-site.