Efficacy of distinct energy delivery protocols comparing two biphasic defibrillators for cardiac arrest

Walsh, Simon; McClelland, Anthony; Owens, Colum; Jg, Allen; Anderson, John; Turner, Colin; Adgey, A.A.J.

doi:10.1016/j.amjcard.2004.04.042

Cited by 45 publications

(14 citation statements)

References 5 publications

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“…9,14,27,28 Our finding that rates of both conversion to an organized rhythm and VF termination are significantly affected by the energy level of subsequent shocks has not previously been reported. This finding explicitly confirms an implication of the data reported by Walsh et al 10 and does so in a setting in which many subsequent shocks were delivered for recurrent VF, not solely for persistent VF.…”

Section: Stiell Et Al Randomized Trial Of Biphasic Defibrillation Energysupporting

confidence: 81%

“…However, previous clinical comparison of different biphasic energy levels and dosing regimens is limited to a single, nonrandomized study. 10 The present study extends this body of evidence on biphasic defibrillation during cardiac arrest resuscitation in several important ways. We compared 2 different commonly used biphasic AED first-shock energy doses and documented that they both provide high rates of VF termination and comparable rates of conversion to an organized rhythm.…”

Section: Stiell Et Al Randomized Trial Of Biphasic Defibrillation Energymentioning

confidence: 50%

“…9,[11][12][13]25,26 Several other studies have reported markedly lower VF termination rates for 100-to 150-J biphasic shocks delivered during ALS-level resuscitation care. 10,16 These published reports have focused predominantly on the first shock performance of a single biphasic waveform and energy level. A recent report demonstrated that the efficacy of shocks is lower for subsequent episodes than for initial episodes of VF, even when energy levels up to 360 J are used.…”

Section: Stiell Et Al Randomized Trial Of Biphasic Defibrillation Energymentioning

confidence: 99%

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BIPHASIC Trial

et al. 2007

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Background-There is little clear evidence as to the optimal energy levels for initial and subsequent shocks in biphasic waveform defibrillation. The present study compared fixed lower-and escalating higher-energy regimens for out-of-hospital cardiac arrest. Methods and Results-The Randomized Controlled Trial to Compare Fixed Versus Escalating Energy Regimens forBiphasic Waveform Defibrillation (BIPHASIC Trial) was a multicenter, randomized controlled trial of 221 out-ofhospital cardiac arrest patients who received Ն1 shock given by biphasic automated external defibrillator devices that were randomly programmed to provide, blindly, fixed lower-energy (150-150-150 J) or escalating higher-energy (200-300-360 J) regimens. Patient mean age was 66.0 years; 79.6% were male. The cardiac arrest was witnessed in 63.8%; a bystander performed cardiopulmonary resuscitation in 23.5%; and initial rhythm was ventricular fibrillation/ ventricular tachycardia in 92.3%. The fixed lower-and escalating higher-energy regimen cases were similar for the 106 multishock patients and for all 221 patients. In the primary analysis in multishock patients, conversion rates differed significantly (fixed lower, 24.7%, versus escalating higher, 36.6%; Pϭ0.035; absolute difference, 11.9%; 95% CI, 1.2 to 24.4). Ventricular fibrillation termination rates also were significantly different between groups (71.2% versus 82.5%; Pϭ0.027; absolute difference, 11.3%; 95% CI, 1.6 to 20.9). For the secondary analysis of first shock success, conversion rates were similar between the fixed lower and escalating higher study groups (38.4% versus 36.7%; Pϭ0.92), as were ventricular fibrillation termination rates (86.8% versus 88.8%; Pϭ0.81). There were no distinguishable differences between regimens for survival outcomes or adverse effects. Conclusions-This is the first randomized trial to compare fixed lower and escalating higher biphasic energy regimens in out-of-hospital cardiac arrest, and it demonstrated higher rates of ventricular fibrillation conversion and termination with an escalating higher-energy regimen for patients requiring multiple shocks. These results suggest that patients in ventricular fibrillation benefit from higher biphasic energy levels if multiple defibrillation shocks are required.

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Section: Stiell Et Al Randomized Trial Of Biphasic Defibrillation Energysupporting

confidence: 81%

Section: Stiell Et Al Randomized Trial Of Biphasic Defibrillation Energymentioning

confidence: 50%

Section: Stiell Et Al Randomized Trial Of Biphasic Defibrillation Energymentioning

confidence: 99%

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BIPHASIC Trial

et al. 2007

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“…Evidence from 1 well-conducted randomized trial (LOE 1) 74 and 1 other human study (LOE 2) 75 employing BTE waveforms suggested that higher energy levels are associated with higher shock-success rates. In the randomized trial, the first-shock success rate was similar with 150 J and 200 J.…”

Section: Consensus On Science Biphasic Truncated Exponential (Bte) Wamentioning

confidence: 99%

Part 6: Defibrillation

Sunde¹,

Deakin²,

Hazinski³

et al. 2010

Circulation

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“…Multiple prospective human clinical studies 23,52,53 and retrospective studies 21,22,39,48,62,63 have failed to identify an optimal biphasic energy level for first or subsequent shocks. Human studies 50,52 have not demonstrated evidence of harm from any biphasic waveform defibrillation energy up to 360 J, with harm defined as elevated biomarker levels, ECG findings, and reduced ejection fraction.…”

Section: Fixed and Escalating Energymentioning

confidence: 99%