Comparison of Low-Energy Versus High-Energy Biphasic Defibrillation Shocks Following Prolonged Ventricular Fibrillation

Walcott, Gregory P.; Melnick, Sharon B.; Killingsworth, Cheryl R.; Ideker, Raymond E.

doi:10.3109/10903120903349838

Cited by 18 publications

(17 citation statements)

References 34 publications

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“…36,80 -81 In a recent prolonged cardiac arrest pig study, however, biphasic 360 J shocks did not appear to cause more cardiac damage than biphasic 150 J shocks (LOE 5). 82 Human studies involving BTE waveforms 74,83 with energy levels up to 360 J have not shown harm as indicated by biomarker levels, ECG findings, and ejection fractions.…”

Section: Myocardial Damage Associated With Higher-energy Levelmentioning

confidence: 99%

Part 6: Defibrillation

Sunde¹,

Deakin²,

Hazinski³

et al. 2010

Circulation

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Section: Myocardial Damage Associated With Higher-energy Levelmentioning

confidence: 99%

Part 6: Defibrillation

Sunde¹,

Deakin²,

Hazinski³

et al. 2010

Circulation

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“…Initiating defibrillation either at 150 J or at 200 J biphasic waveform energy does not result in any significant difference in outcomes for first-shock effect. An animal study comparing first shock of 150 J versus 360 J showed no difference in ROSC rates 16. A randomized comparison of fixed lower (150 J) versus escalating HE (beginning at 200 J) levels for defibrillation in out-of-hospital cardiac arrest (BIPHASIC Trial.…”

Section: Discussionmentioning

confidence: 99%

“…Wide variations were reported in VF termination rates using LE biphasic shocks 13–15. Very few laboratory trials have been conducted to determine whether fixed LE or escalating HE protocols would provide the best chances for successful defibrillation 16,17. An out-of-hospital study demonstrated potential for good survival with escalating HE shocks 18.…”

Section: Introductionmentioning

confidence: 99%

A multicenter prospective randomized study comparing the efficacy of escalating higher biphasic versus low biphasic energy defibrillations in patients presenting with cardiac arrest in the in-hospital environment

Anantharaman¹,

Tay²,

Manning³

et al. 2017

OAEM

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BackgroundBiphasic defibrillation has been practiced worldwide for >15 years. Yet, consensus does not exist on the best energy levels for optimal outcomes when used in patients with ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT).MethodsThis prospective, randomized, controlled trial of 235 adult cardiac arrest patients with VF/VT was conducted in the emergency and cardiology departments. One group received low-energy (LE) shocks at 150–150–150 J and the other escalating higher-energy (HE) shocks at 200–300–360 J. If return of spontaneous circulation (ROSC) was not achieved by the third shock, LE patients crossed over to the HE arm and HE patients continued at 360 J. Primary end point was ROSC. Secondary end points were 24-hour, 7-day, and 30-day survival.ResultsBoth groups were comparable for age, sex, cardiac risk factors, and duration of collapse and VF/VT. Of the 118 patients randomized to the LE group, 48 crossed over to the HE protocol, 24 for persistent VF, and 24 for recurrent VF. First-shock termination rates for HE and LE patients were 66.67% and 64.41%, respectively (P=0.78, confidence interval: 0.65–1.89). First-shock ROSC rates were 25.64% and 29.66%, respectively (P=0.56, confidence interval: 0.46–1.45). The 24-hour, 7-day, and 30-day survival rates were 85.71%, 74.29%, and 62.86% for first-shock ROSC LE patients and 70.00%, 50.00%, and 46.67% for first-shock ROSC HE patients, respectively. Conversion rates for further shocks at 200 J and 300 J were low, but increased to 38.95% at 360 J.ConclusionFirst-shock termination and ROSC rates were not significantly different between LE and HE biphasic defibrillation for cardiac arrest patients. Patients responded best at 150/200 J and at 360 J energy levels. For patients with VF/pulseless VT, consideration is needed to escalate quickly to HE shocks at 360 J if not successfully defibrillated with 150 or 200 J initially.

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“…Prolonged spontaneous or induced ventricular fibrillation, compared to short episodes, required a greater potential gradient for successful defibrillation and to achieve this gradient there was need of higher shock energy (Niemann et al, 2010). After 6 minutes of ventricular www.intechopen.com fibrillation, the first shock defibrillated the heart in 82% of the cases with 360 Joules biphasic shocks and only in 25% of the cases with 150 Joules biphasic shocks (Walcott et al, 2010). There are several clinical conditions, which require higher than usual energy for successful defibrillation: hypertrophic cardiomyopathy, acute ischemia, and several antiarrhythmic agents.…”

Section: Studies Of the Defibrillation Thresholdmentioning

confidence: 99%