Elsevier

Resuscitation

Volume 67, Issues 2–3, November–December 2005, Pages 203-211
Resuscitation

Part 3: Defibrillation

https://doi.org/10.1016/j.resuscitation.2005.09.017Get rights and content

Section snippets

Consensus on science

.

.

No prospective studies have evaluated the use of the precordial (chest) thump. In three case series (LOE 5)2, 3, 4 VF or pulseless VT was converted to a perfusing rhythm by a precordial thump. The likelihood of conversion of VF decreased rapidly with time (LOE 5).4 The conversion rate was higher for unstable or pulseless VT than for VF (LOE 5).2, 3, 4, 5, 6

Several observational studies indicated that an effective thump was delivered by a closed fist from a height of 5–40 cm (LOE 5).3, 4, 6, 7, 8

Consensus on science

.

.

A randomised trial of trained lay responders in public settings (LOE 2)22 and observational studies of CPR and defibrillation performed by trained professional responders in casinos (LOE 5)23 and lay responders in airports (LOE 5)24 and on commercial passenger aircraft (LOE 5)25, 26 showed that AED programmes are safe and feasible and significantly increase survival from out-of-hospital VF cardiac arrest if the emergency response plan is effectively implemented and sustained. In some studies

Position

.

.

.

No studies of cardiac arrest in humans have evaluated the effect of pad/paddle position on defibrillation success or survival rates. Most studies evaluated cardioversion (e.g. atrial fibrillation [AF]) or secondary end points (e.g. transthoracic impedance [TTI]).

Placement of paddles or electrode pads on the superior-anterior right chest and the inferior-lateral left chest were effective (paddles studied in AF, LOE 2;47 pads studied in AF, LOE 3;48 effect of pad position on TTI, LOE 349).

Waveform analysis

VF waveform analysis has the potential to improve the timing and effectiveness of defibrillation attempts; this should minimise interruptions in precordial compressions and reduce the number of unsuccessful high-energy shocks, which cause postresuscitation myocardial injury. The technology is advancing rapidly but is not yet available to assist rescuers.

Initial shock waveform and energy levels

Several related questions were reviewed. Outcome after defibrillation has been studied by many investigators. When evaluating these studies the reviewer must consider the setting (e.g. out-of-hospital versus in-hospital), the initial rhythm (e.g. VF/pulseless VT), the duration of arrests (e.g. out-of-hospital with typical EMS response interval versus electrophysiology study with 15-s arrest interval), and the specific outcome measured (e.g. termination of VF at 5 s).

Consensus on science

.

Only one small human clinical study (LOE 3)101 compared fixed energy with escalating energies using biphasic defibrillators. The study did not identify a clear benefit for either strategy.

Treatment recommendation

Nonescalating- and escalating-energy biphasic waveform defibrillation can be used safely and effectively to terminate VF of both short and long duration.

Consensus on science

.

.

.

No published human or animal studies compared a one-shock protocol with a three-stacked shock sequence for any outcome. The magnitude of success of initial or

Consensus on science

.

Collection of data from defibrillators enables a comparison of actual performance during cardiac arrests and training events. The results of three observational studies (LOE 5)117, 118, 119 suggest that the rate and depth of external cardiac compressions and ventilation rate were at variance with current guidelines.

Treatment recommendation

Monitor/defibrillators modified to enable collection of data on compression rate and depth and ventilation rate may be useful for monitoring and improving process and outcomes after

First page preview

First page preview
Click to open first page preview

References (126)

  • M.J. Cleland et al.

    Problems associated with the Z-fold region of defibrillation electrodes

    J Emerg Med

    (1998)
  • P.A. Calle et al.

    Unreliable post event report from an automated external defibrillator

    Resuscitation

    (2001)
  • A.M. Zafari et al.

    A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy

    J Am Coll Cardiol

    (2004)
  • R.A. Berg et al.

    Automated external defibrillation versus manual defibrillation for prolonged ventricular fibrillation: lethal delays of chest compressions before and after countershocks

    Ann Emerg Med

    (2003)
  • H. Domanovits et al.

    Successful automatic external defibrillator operation by people trained only in basic life support in a simulated cardiac arrest situation

    Resuscitation

    (1998)
  • H. Cusnir et al.

    In hospital cardiac arrest: a role for automatic defibrillation

    Resuscitation

    (2004)
  • N.J. Alp et al.

    Randomised comparison of antero-lateral versus antero-posterior paddle positions for DC cardioversion of persistent atrial fibrillation

    Int J Cardiol

    (2000)
  • L.A. Garcia et al.

    Transthoracic defibrillation: does electrode adhesive pad position alter transthoracic impedance?

    Resuscitation

    (1998)
  • R.E. Kerber et al.

    Self-adhesive preapplied electrode pads for defibrillation and cardioversion

    J Am Coll Cardiol

    (1984)
  • P. Kirchhof et al.

    Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial

    Lancet

    (2002)
  • C.D. Deakin et al.

    Is the orientation of the apical defibrillation paddle of importance during manual external defibrillation?

    Resuscitation

    (2003)
  • L.A. Pagan-Carlo et al.

    Transthoracic defibrillation: importance of avoiding electrode placement directly on the female breast

    J Am Coll Cardiol

    (1996)
  • K.G. Kanz et al.

    Susceptibility of automated external defibrillators to train overhead lines and metro third rails

    Resuscitation

    (2004)
  • G.W. Dalzell et al.

    Electrode pad size, transthoracic impedance and success of external ventricular defibrillation

    Am J Cardiol

    (1989)
  • E.D. Thomas et al.

    Effectiveness of direct current defibrillation: role of paddle electrode size

    Am Heart J

    (1977)
  • R.A. Samson et al.

    Optimal size of self-adhesive preapplied electrode pads in pediatric defibrillation

    Am J Cardiol

    (1995)
  • C.R. Killingsworth et al.

    Defibrillation threshold and cardiac responses using an external biphasic defibrillator with pediatric and adult adhesive patches in pediatric-sized piglets

    Resuscitation

    (2002)
  • C.D. Deakin et al.

    A comparison of transthoracic impedance using standard defibrillation paddles and self-adhesive defibrillation pads

    Resuscitation

    (1998)
  • R.E. Kerber et al.

    Experimental evaluation and initial clinical application of new self-adhesive defibrillation electrodes

    Int J Cardiol

    (1985)
  • C.D. Deakin

    Paddle size in defibrillation

    Br J Anaesth

    (1998)
  • R.M. Bojar et al.

    Use of self-adhesive external defibrillator pads for complex cardiac surgical procedures

    Ann Thorac Surg

    (1988)
  • J. Brown et al.

    Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review

    Resuscitation

    (2001)
  • R.F. Wilson et al.

    Defibrillation of high-risk patients during coronary angiography using self-adhesive, preapplied electrode pads

    Am J Cardiol

    (1987)
  • N. Bradbury et al.

    Reliability of ECG monitoring with a gel pad/paddle combination after defibrillation

    Resuscitation

    (2000)
  • C.G. Brown et al.

    Signal analysis of the human electrocardiogram during ventricular fibrillation: frequency and amplitude parameters as predictors of successful countershock

    Ann Emerg Med

    (1996)
  • M. Callaham et al.

    Prehospital cardiac arrest treated by urban first-responders: profile of patient response and prediction of outcome by ventricular fibrillation waveform

    Ann Emerg Med

    (1993)
  • H.U. Strohmenger et al.

    Analysis of the ventricular fibrillation ECG signal amplitude and frequency parameters as predictors of countershock success in humans

    Chest

    (1997)
  • M. Podbregar et al.

    Predicting defibrillation success by ‘genetic’ programming in patients with out-of-hospital cardiac arrest

    Resuscitation

    (2003)
  • K.G. Monsieurs et al.

    A rule for early outcome classification of out-of-hospital cardiac arrest patients presenting with ventricular fibrillation

    Resuscitation

    (1998)
  • H.P. Povoas et al.

    Predicting the success of defibrillation by electrocardiographic analysis

    Resuscitation

    (2002)
  • H.U. Strohmenger et al.

    Spectral analysis of ventricular fibrillation and closed-chest cardiopulmonary resuscitation

    Resuscitation

    (1996)
  • C.B. Lightfoot et al.

    Dynamic nature of electrocardiographic waveform predicts rescue shock outcome in porcine ventricular fibrillation

    Ann Emerg Med

    (2003)
  • F.A. Hamprecht et al.

    Fibrillation power, an alternative method of ECG spectral analysis for prediction of countershock success in a porcine model of ventricular fibrillation

    Resuscitation

    (2001)
  • A. Amann et al.

    Analysing ventricular fibrillation ECG-signals and predicting defibrillation success during cardiopulmonary resuscitation employing N(alpha)-histograms

    Resuscitation

    (2001)
  • C.G. Brown et al.

    Median frequency—a new parameter for predicting defibrillation success rate

    Ann Emerg Med

    (1991)
  • L.J. Morrison et al.

    Out-of-hospital cardiac arrest rectilinear biphasic to monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT)

    Resuscitation

    (2005)
  • A.P. van Alem et al.

    A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest

    Resuscitation

    (2003)
  • P.R. Martens et al.

    Optimal Response to Cardiac Arrest study: defibrillation waveform effects

    Resuscitation

    (2001)
  • J.C. Stothert et al.

    Rectilinear biphasic waveform defibrillation of out-of-hospital cardiac arrest

    Prehosp Emerg Care

    (2004)
  • J. Carpenter et al.

    Defibrillation waveform and post-shock rhythm in out-of-hospital ventricular fibrillation cardiac arrest

    Resuscitation

    (2003)
  • Cited by (0)

    View full text