{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:18:12Z","timestamp":1747196292456,"version":"3.40.5"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>Out-of-hospital cardiac arrest (OHCA) has a poor prognosis, with an overall survival rate of about 5% at discharge. Shockable rhythm cardiac arrests (ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)) have a better prognosis. In case of shockable rhythm, treatment is based on defibrillation, and thereafter, in case of failure of 3 external electric shocks (EES), on direct intravenous administration of 300 mg amiodarone, or lidocaine when amiodarone is unavailable or inefficient.<\/jats:p>\n<jats:p>During surgical procedures under extracorporeal circulation, a high potassium cardioplegia solution is administered to interrupt cardiac activity and facilitate surgical procedure. By extension, direct intravenous administration of potassium chloride (KCl) has been shown to convert VF, resulting in return to a hemodynamically efficient organized heart rate within a few minutes.<\/jats:p>\n<jats:p>The aim of this study is to provide clinical evidence that direct intravenous injection of KCl, into a patient presenting with OHCA due to refractory VF although 3 EES, should interrupt this VF and then allow rapid restauration of an organized heart rhythm, and thus return of spontaneous circulation (ROSC).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A multicenter, prospective, single group, phase 2 study will be conducted on 81 patients presenting with refractory VF. After failure of 3 EES, each patient will receive direct intravenous injection of 20 mmol KCl instead of amiodarone. The primary outcome will be survival rate at hospital admission. Major secondary outcomes will include ROSC and time to ROSC in the prehospital setting, number of VF recidivism after KCl injection, survival rate at hospital discharge with a good neurologic prognostic, and survival rate 3 months after hospital discharge with a good neurologic prognostic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>No patient is currently included in the study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Conventional guideline strategy based on antiarrhythmic drug administration, i.e. amiodarone or lidocaine, for OHCA due to shockable rhythm, has not yet demonstrated an increase in survival at hospital admission or at hospital discharge. This may be related to the major cardiodepressant effect of those drugs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04316611\" xlink:type=\"simple\">NCT04316611<\/jats:ext-link>. Registered on March 2020. AP-HP180577 \/ N\u00b0 EUDRACT: 2019-002544-24. Funded by the French Health Ministry. <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04316611\" xlink:type=\"simple\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04316611<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284429","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T17:35:40Z","timestamp":1681320940000},"page":"e0284429","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the effectiveness of potassium chloride in the management of out-of hospital cardiac arrest by refractory ventricular fibrillation: Study protocol of the POTACREH study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2616-6132","authenticated-orcid":true,"given":"Romain","family":"Jouffroy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Ecollan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Chollet-Xemard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertrand","family":"Prunet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Elie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Marc","family":"Treluyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benoit","family":"Vivien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"issue":"6","key":"pone.0284429.ref001","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.lpm.2011.02.026","article-title":"L\u2019arr\u00eat cardiaque en France: pourquoi un registre national?","volume":"40","author":"PY Gueugniaud","year":"2011","journal-title":"Presse Med"},{"issue":"18 Suppl 2","key":"pone.0284429.ref002","first-page":"S444","article-title":"Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.","volume":"132","author":"MS Link","year":"2015","journal-title":"Circulation"},{"key":"pone.0284429.ref003","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.resuscitation.2015.02.003","article-title":"Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC).","volume":"91","author":"Resuscitation Outcomes Consortium Investigators.","year":"2015","journal-title":"Resuscitation"},{"key":"pone.0284429.ref004","first-page":"S 315","article-title":"2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.","volume":"132","author":"American Heart Association","year":"2015","journal-title":"Circulation"},{"key":"pone.0284429.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resuscitation.2015.07.038","article-title":"European Resuscitation Council Guidelines for Resuscitation 2015.","volume":"95","author":"European Resuscitation Council","year":"2015","journal-title":"Resuscitation"},{"issue":"18","key":"pone.0284429.ref006","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1056\/NEJMoa1514204","article-title":"Resuscitation Outcomes Consortium Investigators. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest","volume":"374","author":"PJ Kudenchuk","year":"2016","journal-title":"N Engl J Med"},{"key":"pone.0284429.ref007","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/0002-9149(61)90462-3","article-title":"Successful treatment of ventricular fibrillation with intracardiac potassium chloride.","volume":"7","author":"L Weinstock","year":"1961","journal-title":"Am J Cardiol"},{"issue":"1","key":"pone.0284429.ref008","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0022-5223(19)37456-2","article-title":"Biochemical termination of sustained fibrillation occurring after artificially induced ischemic arrest.","volume":"87","author":"F. Robicsek","year":"1984","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"pone.0284429.ref009","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0003-4975(95)00327-4","article-title":"Conversion of postischemic ventricular fibrillation with intraaortic infusion of potassium chloride.","volume":"60","author":"E \u00d8vrum","year":"1995","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"pone.0284429.ref010","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/icvts\/ivs455","article-title":"Potassium-induced conversion of ventricular fibrillation after aortic declamping.","volume":"16","author":"SM Almdahl","year":"2013","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"6","key":"pone.0284429.ref011","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1016\/j.athoracsur.2010.02.052","article-title":"Resuscitation after prolonged cardiac arrest: role of cardiopulmonary bypass and systemic hyperkalemia.","volume":"89","author":"OJ Liakopoulos","year":"2010","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"pone.0284429.ref012","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.athoracsur.2010.07.075","article-title":"Potassium-induced cardiac resetting technique for persistent ventricular tachycardia and fibrillation after aortic declamping.","volume":"91","author":"G Watanabe","year":"2011","journal-title":"Ann Thorac Surg"},{"issue":"8","key":"pone.0284429.ref013","doi-asserted-by":"crossref","first-page":"e118","DOI":"10.1016\/j.resuscitation.2013.12.038","article-title":"A new approach for treatment of refractory ventricular fibrillation allowed by extra corporeal life support (ECLS)?","volume":"85","author":"R Jouffroy","year":"2014","journal-title":"Resuscitation"},{"issue":"6","key":"pone.0284429.ref014","doi-asserted-by":"crossref","first-page":"H2665","DOI":"10.1152\/ajpheart.2000.279.6.H2665","article-title":"Effects of [K(+)](o) on electrical restitution and activation dynamics during ventricular fibrillation.","volume":"279","author":"ML Koller","year":"2000","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"10","key":"pone.0284429.ref015","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1016\/j.bpj.2010.02.011","article-title":"Mechanisms underlying the antifibrillatory action of hyperkalemia in Guinea pig hearts","volume":"98","author":"SV Pandit","year":"2010","journal-title":"Biophys J"},{"issue":"4","key":"pone.0284429.ref016","doi-asserted-by":"crossref","first-page":"249","DOI":"10.3109\/14017431.2014.922212","article-title":"Postcardioplegia ventricular fibrillation: no impact on subsequent survival","volume":"48","author":"SM Almdahl","year":"2014","journal-title":"Scand Cardiovasc J"},{"issue":"1","key":"pone.0284429.ref017","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.resuscitation.2004.04.001","article-title":"International EMS systems: France.","volume":"63","author":"F Adnet","year":"2004","journal-title":"Resuscitation"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0284429","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T17:35:51Z","timestamp":1681320951000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0284429"}},"subtitle":[],"editor":[{"given":"Yoshihiro","family":"Fukumoto","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,4,12]]},"references-count":17,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0284429","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2023,4,12]]}}}