Optimal Response to Cardiac Arrest study: Defibrillation waveform effects

Martens, Patrick; Russell, James K.; Wolcke, Benno; Paschen, H.-R.; Kuisma, Markku; Gliner, Bradford E.; Weaver, W. Douglas; Bossaert, Leo; Chamberlain, Douglas; Schneider, Thomas

doi:10.1016/s0300-9572(01)00321-5

Cited by 94 publications

(28 citation statements)

References 20 publications

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“…In terms of AED models providing different shock waveforms, only few studies have been conducted with no evidence supporting on type of biphasic waveform instead of the other,36, 37, 38, 39 which is also supported by this study. Concerning AED energy levels ERC recommendations state that the initial biphasic shock energy should be at least 150 J for all waveforms.…”

Section: Discussionsupporting

confidence: 74%

Return of spontaneous circulation and long‐term survival according to feedback provided by automated external defibrillators

Agerskov

Hansen

Nielsen

et al. 2017

Acta Anaesthesiol Scand

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BackgroundWe aimed to investigate the effect of automated external defibrillator (AED) feedback mechanisms on survival in out‐of‐hospital cardiac arrest (OHCA) victims. In addition, we investigated converting rates in patients with shockable rhythms according to AED shock waveforms and energy levels.MethodsWe collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs.ResultsA total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68%). We found no difference in return of spontaneous circulation (ROSC) at hospital arrival according to AV‐feedback; 34 (55%, 95% confidence interval (CI) [13–67]) vs. 72 (54%, 95% CI [45–62]), P = 1 (odds ratio (OR) 1.1, 95% CI [0.6–1.9]) or 30‐day survival; 24 (39%, 95% CI [28–51]) vs. 53 (40%, 95% CI [32–49]), P = 0.88 (OR 1.1 (95% CI [0.6–2.0])). Moreover, we found no difference in converting rates among patients with initial shockable rhythm receiving one or more shocks according to AED energy waveform and energy level.ConclusionsNo difference in survival after OHCA according to AED feedback mechanisms, nor any difference in converting rates according to AED waveform or energy levels was detected.

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Section: Discussionsupporting

confidence: 74%

Return of spontaneous circulation and long‐term survival according to feedback provided by automated external defibrillators

Agerskov

Hansen

Nielsen

et al. 2017

Acta Anaesthesiol Scand

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“…Já para estudos de intervenção, como no presente caso, os estudos randomizados ou aleatorizados são os mais adequados. Isto se deve ao fato de potencialmente eliminarem os fatores de con- Bain AC et al 9 Martens PR et al 12 Carpenter J et al 11 Morrison LJ et al 13 Kudenchuk PJ et al 5 Algumas perguntas impedem que se utilize os estudos aleatorizados por motivos éticos, como por exemplo, na avaliação de fatores de risco como tabagismo para câncer de pulmão. Nestes casos, outros tipos de estudo, como os estudos de coorte, são utilizados e existem técnicas para lidar com os fatores de confusão, como a estratificação ou a regressão.…”

Section: Tabelaunclassified

“…Já os demais estudos utilizaram como modelo a parada cardíaca extra-hospitalar, randomizando o tipo de aparelho utilizado para o atendimento de acordo com o dia da semana, por exemplo. 8,[11][12][13] Este desenho é mais próximo do real e permite a generalização para os pacientes com parada cardíaca extra-hospitalar. Já é conhecido que o prognóstico dos casos extra-hospitalares é muito melhor em relação ao intra-hospitalar, sendo razoável supor que a generalização dos dados para o contexto intra-hospitalar, que é o nosso interesse, seria passível de críticas.…”

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Devo jogar o meu desfibrilador monofásico fora? – Um exercício de Medicina Baseada em Evidência

Pazin‐Filho

2010

Medicina (Ribeirão Preto)

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“…durch eine spontane pathologische Erregung in Form von Extrasystolen (R-auf-TPhänomen) im Randgebiet ischämischer Zonen kommen [17,43,77]. Bezüglich der erfolgreichen Rhythmuskonversion durch monophasische Impulsformen konnten Bain et al [10] eine verbesserte "first-shock efficacy" des MTEImpulses ermittelt,hingegen konnten Behr et al [15],Martens et al [54] und van Alem et al [2] einen Vorteil der MDS-im Vergleich zur MTE-Impulsform aufzeigen.…”

Section: Bedeutung Der Unterschiedlichen Ursachen Des Kammerflimmernsunclassified

Die transthorakale Defibrillation

et al. 2004

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As one major link in the chain of survival, early transthoracic (external) cardiac defibrillation is aimed at the termination of ventricular flutter and ventricular fibrillation. Most important to the success of defibrillation is the passage of a defined amount of current through a critical mass of heart muscle. Different transthoracic resistances reduce the effective density of the current within the heart. As for other therapeutic intervention procedures, recommendations for the optimal strength of current to be applied to the fibrillating heart need to be evaluated and defined for therapeutical defibrillation too. Unnecessarily high current density causes damage to the heart and should be prevented. By using biphasic waveforms in contrast to monophasic impulses, the amount of current can be reduced but the same or even higher efficacy is attained. Therefore possible myocardial damage might be clearly reduced. Even with individually altered thoracic impedance effective conversion of cardiac rhythm can be achieved by device-controlled compensation and biphasic waveforms. According to their different mechanisms or origin (electrically induced or spontaneously caused by organic heart disease) the probability of successful conversion of the cardiac rhythm by one single electrical impulse varies. The optimum point in time for defibrillation during resuscitation needs to be redefined. In order to improve comparability, further studies should use standardized definitions for successful defibrillation relating to the resulting cardiac rhythm.

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Optimal Response to Cardiac Arrest study: Defibrillation waveform effects

Cited by 94 publications

References 20 publications

Return of spontaneous circulation and long‐term survival according to feedback provided by automated external defibrillators

Return of spontaneous circulation and long‐term survival according to feedback provided by automated external defibrillators

Devo jogar o meu desfibrilador monofásico fora? – Um exercício de Medicina Baseada em Evidência

Die transthorakale Defibrillation

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