Advances in defibrillation

Abstract

The focus of these articles is to improve the delivery of defibrillation without interrupting chest compression and aiming to do so at an optimal stage of the resuscitation attempt.

The need to resume chest compressions immediately after defibrillation attempts: An analysis of post-shock rhythms and duration of pulselessness following out-of-hospital cardiac arrest

“…It may not be successful in many cases and it can induce arrhythmias or result in myocardial stunning. However, those are all acceptable risks because defibrillation is the most definitive therapy for patients presenting with cardiac arrest due to VF or VT. 20 Despite risks such as rib fractures, life-threatening complications from performing chest compressions are rare. 21 One study did suggest that chest compressions could cause the recurrence of VF after the first successful conversion in patients with out-of-hospital cardiac arrest.…”

Cardioversion and Defibrillation

“…It is believed that monophasic defibrillators usually require higher-energy shock than biphasic defibrillators. 8 With monophasic defibrillators, it was previously recommended to deliver up to three successive shocks if the first one was unsuccessful to decrease transthoracic impedance and therefore increase the amount of energy delivered to the myocardium with the second and the third shocks. 9 In a research setting the author determined in a few healthy dogs that a biphasic shock with an energy of 4 J/kg consistently terminated ventricular fibrillation, whereas an energy of 3 J/kg was less likely to be successful.…”

“…9 In a research setting the author determined in a few healthy dogs that a biphasic shock with an energy of 4 J/kg consistently terminated ventricular fibrillation, whereas an energy of 3 J/kg was less likely to be successful. 8 Open chest cardiac defibrillation is rarely indicated in veterinary patients unless ventricular fibrillation occurs in the operating room. It is usually suggested that the operator aim at using the lowest amount of energy possible.…”

“…Pediatric paddles have been recommended for animals weighing less than 15 kg (see Figure 204-1). 8 Before defibrillation is performed, the person who is responsible for initiating the shock should ascertain that staff are not in contact with the animal and stand clear. Firm manual pressure is then applied to the paddles to literally squeeze the heart between the paddles and decrease the thoracic impedance.…”