The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function

Tang, Wanchun; Weil, Max Harry; Sun, Shijie; Yamaguchi, Hitoshi; Póvoas, Heitor P.; Pernat, Andreja Marn; Bisera, Joe

doi:10.1016/s0735-1097(99)00270-3

Cited by 194 publications

(91 citation statements)

References 31 publications

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“…In confirmation of earlier investigations, postresuscitation myocardial dysfunction was largely reversed after 72 hours in the absence of interruption other than for Ͻ3 seconds during delivery of the shock. 2, 29 We therefore implicate interruptions in chest compression, resulting in critical reductions in myocardial perfusion and with exacerbation of global ischemic injury of the heart, as explanations for the outcomes, especially in settings in which ventricular fibrillation consumes disproportionately large myocardial oxygen demands. 30,31 To this extent, the present studies only extend the well-established understanding that the longer the duration of myocardial ischemia, the greater is the impairment in myocardial function, whether it be a result of regional or global ischemia.…”

Section: Discussionmentioning

confidence: 99%

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

et al. 2002

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Background-Current versions of automated external defibrillators (AEDs) require frequent stopping of chest compression for rhythm analyses and capacity charging. The present study was undertaken to evaluate the effects of these interruptions during the operation of AEDs. Methods and Results-Ventricular fibrillation was electrically induced in 20 male domestic swine weighing between 37. 5 and 43 kg that were untreated for 7 minutes before CPR was started. Defibrillation was attempted with up to 3 sequential 150-J biphasic shocks, but each was preceded by 3-, 10-, 15-, or 20-second interruptions of chest compression. The interruptions corresponded to those that were mandated by commercially marketed AEDs for rhythm analyses and capacitor charge. The sequence of up to 3 electrical shocks and delays were repeated at 1-minute intervals until the animals were successfully resuscitated or for a total of 15 minutes. Spontaneous circulation was restored in each of 5 animals in which precordial compression was delayed for 3 seconds before the delivery of the first and subsequent shocks but in none of the animals in which the delay was Ͼ15 seconds before the delivery of the first and subsequent shocks. Longer intervals of CPR interventions were required, and there was correspondingly greater failure of resuscitation in close relationship to increasing delays. The durations of interruptions were inversely related to the durations of subthreshold levels of coronary perfusion pressure. Postresuscitation arterial pressure and left ventricular ejection fraction were more severely impaired with increasing delays. Key Words: cardiopulmonary resuscitation Ⅲ fibrillation Ⅲ defibrillation Ⅲ compression Ⅲ myocardium A utomated external defibrillators (AEDs) provide the single best option for improving the currently poor outcomes of out-of-hospital cardiopulmonary resuscitation (CPR) performed by bystanders. Fundamental to the operation of AEDs is the capability of automated ECG rhythm analyses, during which CPR is interrupted. Previous experimental studies had demonstrated both decreased resuscitability and greater impairment of postresuscitation myocardial function and survival when precordial compression was interrupted for 20 seconds in small animals. 1-3 Because current versions of AEDs prompt "hands-off" intervals of Ͼ10 seconds for rhythm analyses before advising the rescuer to deliver an electrical shock, as documented below, we hypothesized that such interruptions would adversely affect the outcomes of CPR. Conclusions-InterruptionsThreshold levels of coronary perfusion pressure (CPP) are identified as major determinants of successful cardiac resuscitation. 4 -7 Interruptions in precordial compression predictably result in declines in CPP and therefore delays in restoring threshold values of CPP. 5,6 We therefore anticipated that increasing the length of intervals of interrupted chest compression results in corresponding decreases in the success of CPR and greater severity of postresuscitation myocardial dysfunction.These co...

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Section: Discussionmentioning

confidence: 99%

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

et al. 2002

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“…[33][34][35] One study found that the use of biphasic waveforms was associated with significantly better postresuscitation myocardial function than monophasic waveforms, even with the same high energies and capacitance typically used for monophasic defibrillation. 36 These studies demonstrate the safety of pediatric defibrillation shocks, even at energy doses significantly higher than the current 4-J/kg recommendations, and especially when the number of shocks delivered is minimized.…”

Section: Aed Energy and Waveform Safety And Efficacymentioning

confidence: 70%

T He U Se of a Utomated E Xternal D Efibrillators in C Hildren

Markenson

Domeier²,

Standards³

2003

Prehospital Emergency Care

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“…9) The cause of increased risk may be postulated that the negative inotropic consequences of the shock itself could increase the risk of death, especially when the patient receives multiple shocks due to oversensing or in response to ongoing supraventricular tachycardia. [10][11][12][13] Thus, effective strategies to reduce ICD shocks are desirable. Antiarrhythmic medication is frequently administered in patients with an ICD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Additional Amiodarone Therapy in Patients with an Implantable Cardioverter‐Defibrillator

Matsumoto

Kumagai

Ogawa

et al. 2010

Journal of Arrhythmia

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Introduction: We examined whether the additional use of amiodarone (AMD) under implantable cardioverter-defibrillator (ICD) therapy may have beneficial effects in patients at risk for lethal ventricular arrhythmias with structural heart diseases.Methods: Sixty patients (47 males, mean age, 62 AE 13 years) with structural heart disease who underwent ICD implantation were retrospectively analyzed. There were 2 groups: one group (AMD group) was treated with AMD (n ¼ 33) and the other group (non-AMD group) was treated without AMD (n ¼ 27). We compared the incidence and appropriateness of ICD shock therapy between two groups.Results: During a mean follow-up of 28 AE 17 months, we identified a total of 62 episodes in 18 patients (30%) who received ICD shock therapy. ICD shock episodes were significantly less frequent in AMD group than in non-AMD group (15% versus 48%, P < 0:01), while inappropriate shock episodes were greater in non-AMD group than in AMD group (49% versus 4%, P ¼ 0:03). In cumulative probability of shock events, the risk of events was significantly lower in AMD group (P ¼ 0:007). Of 4 patients who died in AMD group, we observed one fatal pulmonary fibrosis.Conclusions: Additional AMD therapy in patients with an ICD may be effective in reducing the risk of shock discharge. (J Arrhythmia 2010; 26: 103-110)

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The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function

Cited by 194 publications

References 31 publications

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

T He U Se of a Utomated E Xternal D Efibrillators in C Hildren

Efficacy of Additional Amiodarone Therapy in Patients with an Implantable Cardioverter‐Defibrillator

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