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Peer-reviewedCC BY-NC-ND 4.0Resuscitation Plus

Strategies for defibrillation during out-of-hospital cardiac arrest – protocol for a randomised clinical trial

  • Bertram Lahn Kirkegaard1,2,3
  • Mikael Fink Vallentin1,2,3
  • Carsten Meilandt1
  • Christian Juhl Terkelsen4
  • Allan Bach1
  • Kristian Blumensaadt Winther1
  • Søren Mikkelsen5
  • Helle Collatz Christensen6
  • Steffen Christensen3
  • Thomas Dissing1
  • Thomas Lass Klitgaard7
  • Fredrik Folke8,9
7 more authors
  • Jacob Steinmetz10
  • Markus B. Skrifvars11
  • Cornelia Genbrugge12,13
  • Siobhan Masterson14,15
  • Marko Hoikka16
  • Asger Granfeldt2,3
  • Lars W. Andersen1,2,3
16 affiliations
  1. 1Prehospital Emergency Medical Services, Central Denmark Region, Denmark
  2. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  3. 3Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
  4. 4Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  5. 5The Prehospital Research Unit, Region of Southern Denmark, Denmark
  6. 6The Prehospital Center, Region Zealand, Denmark
  7. 7Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
  8. 8Copenhagen Emergency Medical Services, Capital Region of Denmark, Denmark
  9. 9Department of Clinical Medicine, Copenhagen University, Denmark
  10. 10Danish Air Ambulance, Aarhus University, Aarhus, Denmark
  11. 11Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
  12. 12Emergency Department, University Hospitals Leuven, Leuven, Belgium
  13. 13Department of Primary Care and Public Health, Emergency Medicine, Catholic University Leuven, Belgium
  14. 14Clinical Directorate, HSE National Ambulance Service, Limerick, Ireland
  15. 15School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
  16. 16Centre for Prehospital Emergency Care, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Abstract

Background: There is a lack of evidence regarding which defibrillation strategy is the most effective during resuscitation. Anterior-posterior pad placement and double sequential defibrillation have been proposed as alternatives to standard anterior-lateral defibrillation for patients with refractory shockable rhythms, but evidence remains limited.

Objective: This trial will investigate whether there is a difference in 30-day survival when using anterior-posterior and double sequential defibrillation as compared to standard anterior-lateral defibrillation in adults with out-of-hospital cardiac arrest and a shockable rhythm.

Methods: This trial is an investigator-initiated, individually randomised, 3-group, clinical trial enrolling adult patients with out-of-hospital cardiac arrest with at least one emergency medical services defibrillation attempt and if the last known rhythm is shockable and two manual defibrillators are available. Participants are randomised 1:1:1 to anterior-lateral defibrillation, anterior-posterior defibrillation, or double sequential defibrillation. The trial is planned to be conducted in Denmark, Finland, Belgium, and Ireland.

The primary outcome is 30-day survival, with key secondary outcomes of 90-day survival and neurological status at 30 and 90-days assessed using the modified Rankin Scale. Additional outcomes include return of spontaneous circulation, hospital disposition, health-related quality of life, and longer-term survival and neurological outcomes.

The planned sample size is 909 participants. Enrollment began in March 2025. 320 patients have been enrolled by September 2026. The trial is registered at ClinicalTrials.gov (identifier: NCT06781892).

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Cite

BibTeXRIS
BibTeX
@article{kirkegaard2026strategies,
  title = {{Strategies for defibrillation during out-of-hospital cardiac arrest – protocol for a randomised clinical trial}},
  author = {Bertram Lahn Kirkegaard and Mikael Fink Vallentin and Carsten Meilandt and Christian Juhl Terkelsen and Allan Bach and Kristian Blumensaadt Winther and Søren Mikkelsen and Helle Collatz Christensen and Steffen Christensen and Thomas Dissing and Thomas Lass Klitgaard and Fredrik Folke and Jacob Steinmetz and Markus B. Skrifvars and Cornelia Genbrugge and Siobhan Masterson and Marko Hoikka and Asger Granfeldt and Lars W. Andersen},
  journal = {Resuscitation Plus},
  year = {2026},
  month = oct,
  doi = {10.1016/j.resplu.2026.101512},
  url = {https://doi.org/10.1016/j.resplu.2026.101512},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Strategies for defibrillation during out-of-hospital cardiac arrest – protocol for a randomised clinical trial
AU  - Bertram Lahn Kirkegaard
AU  - Mikael Fink Vallentin
AU  - Carsten Meilandt
AU  - Christian Juhl Terkelsen
AU  - Allan Bach
AU  - Kristian Blumensaadt Winther
AU  - Søren Mikkelsen
AU  - Helle Collatz Christensen
AU  - Steffen Christensen
AU  - Thomas Dissing
AU  - Thomas Lass Klitgaard
AU  - Fredrik Folke
AU  - Jacob Steinmetz
AU  - Markus B. Skrifvars
AU  - Cornelia Genbrugge
AU  - Siobhan Masterson
AU  - Marko Hoikka
AU  - Asger Granfeldt
AU  - Lars W. Andersen
PY  - 2026
DA  - 2026/10/06
JO  - Resuscitation Plus
DO  - 10.1016/j.resplu.2026.101512
UR  - https://doi.org/10.1016/j.resplu.2026.101512
AB  - Background: There is a lack of evidence regarding which defibrillation strategy is the most effective during resuscitation. Anterior-posterior pad placement and double sequential defibrillation have been proposed as alternatives to standard anterior-lateral defibrillation for patients with refractory shockable rhythms, but evidence remains limited.  Objective: This trial will investigate whether there is a difference in 30-day survival when using anterior-posterior and double sequential defibrillation as compared to standard anterior-lateral defibrillation in adults with out-of-hospital cardiac arrest and a shockable rhythm.  Methods: This trial is an investigator-initiated, individually randomised, 3-group, clinical trial enrolling adult patients with out-of-hospital cardiac arrest with at least one emergency medical services defibrillation attempt and if the last known rhythm is shockable and two manual defibrillators are available. Participants are randomised 1:1:1 to anterior-lateral defibrillation, anterior-posterior defibrillation, or double sequential defibrillation. The trial is planned to be conducted in Denmark, Finland, Belgium, and Ireland.  The primary outcome is 30-day survival, with key secondary outcomes of 90-day survival and neurological status at 30 and 90-days assessed using the modified Rankin Scale. Additional outcomes include return of spontaneous circulation, hospital disposition, health-related quality of life, and longer-term survival and neurological outcomes.  The planned sample size is 909 participants. Enrollment began in March 2025. 320 patients have been enrolled by September 2026. The trial is registered at ClinicalTrials.gov (identifier: NCT06781892).
SN  - 2666-5204
ER  -