A study of patients in cardiac arrest due to ventricular arrhythmias to determine if manual pressure augmentation during defibrillation improves neurological outcome and survival

Patients in the treatment arm who have a shockable rhythm (VF or VT) will undergo defibrillation of 200J. During shock delivery, paramedics will apply manual maximum pressure to both defibrillation patches while the charge is delivered. If return of spontaneous circulation (ROSC) is not achieved, CPR is continued. Every 2 minutes, a rhythm check will be conducted and if the patient is still in a shockable rhythm, another shock will be given with manual pressure augmentation. This process will be repeated each time a shock is given as per the standard resuscitation protocol until ROSC is achieved or resuscitation is ceased. The treatment will be administered by Advanced Life Support and Mobile Intensive Care paramedics and training will be provided via a single 30 minute online learning module and face to face scenario training prior to the trial commencing. Paramedics will also have ongoing access to a trial intranet page with Q&A content and training videos. Trial participation will be voluntary for paramedics and a review of ambulance patient care records will be conducted for each arrest to determine if the intervention was utilised.