AUGMENT – Manual Pressure Augmentation in Defibrillation of Ventricular Arrhythmias

A cluster randomised trial involving 1,500 participants, comparing the efficacy and safety of manual pressure augmentation (MPA) compared with standard defibrillation in out-of-hospital cardiac arrests (OHCA).

Chief Investigators

Prof Dion Stub, Dr Ziad Nehme, Prof Karen Smith, A/Prof Aleksandr Voskoboinik

Funding source

Heart Foundation Vanguard Grant

Estimated completion date

December 2024

Background

Standard defibrillation during an OHCA involves the defibrillator operator standing back and isolating the patient whilst shocks are delivered. MPA involves an operator wearing gloves pushing down on the sternal and apical patches at the time of energy delivery using either a clenched fist or open palm.

First defibrillation success rates using standard defibrillation techniques for OHCA vary between 50% and 79%. Prior research led by Chief Investigator Voskoboinik has demonstrated that when cardioverting atrial fibrillation - a non-life-threatening arrhythmia - MPA on pads had superior outcomes compared to standard practice. This technique has never been robustly studied in the context of life-threatening OHCA, where it has the real potential to save lives.

Aim

To assess the efficacy and safety of defibrillation with MPA compared to standard defibrillation in OHCA.

Outputs to date

Stephens AF, Šeman M, Nehme Z, Voskoboinik A, Smith K, Gregory SD, Stub D. Ex vivo evaluation of personal protective equipment in hands-on defibrillation. Resusc Plus. 2022 Aug 3;11:100284. doi: 10.1016/j.resplu.2022.100284.

Voskoboinik A, Nehme Z, Kistler PM, Stub D, Smith K. First time use of manual pressure augmentation for ventricular fibrillation arrest in the community. Resuscitation. 2022 May;174:31-32. doi: 10.1016/j.resuscitation.2022.03.018. Epub 2022 Mar 21.