Management of cardiac arrest according to published guidelines has remained largely unchanged for a decade. Thames Valley Air Ambulance provide Critical Care Paramedic and Physician teams who respond to cardiac arrests and offer treatments beyond the scope of ambulance service clinicians. Following a review of practice and appraisal of evidence the investigators developed an additional algorithm for cases of adult medical cardiac arrest with refractory shockable rhythms. This adds to but does not replace the Advanced Life Support algorithm and includes: * Delivering shocks with the LUCAS mechanical CPR device running * After 5 shocks have been delivered placing new pads in the Anterior Posterior (AP) position * Delivering shocks using the TVAA Tempus Pro defibrillator rather than the Ambulance Service defibrillator. This bundle was based on recommendations from ILCOR and the Resus Council (UK) Advanced Life Support manual and was launched in October 2021.
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ROSC at hospital
Timeframe: within 24 hours of arrest