Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims

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

doi:10.1161/01.cir.102.15.1780

Cited by 287 publications

(124 citation statements)

References 38 publications

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“…Recent reports have indicated a decrease in the number of laypersons performing CPR. [1][2][3] One reason postulated for this decline in bystander CPR is lay rescuer reluctance to administer mouth-to-mouth breathing. 4,5 The American Heart Association has called for simplification as a central educational theme in efforts to encourage more bystander participation.…”

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confidence: 99%

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

et al. 2002

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Background — Interruptions to chest compression–generated blood flow during cardiopulmonary resuscitation (CPR) are detrimental. Data show that such interruptions for mouth-to-mouth ventilation require a period of “rebuilding” of coronary perfusion pressure to obtain the level achieved before the interruption. Whether such hemodynamic compromise from pausing to ventilate is enough to affect outcome is unknown. Methods and Results — Thirty swine (weight 35±2 kg) underwent 3 minutes of untreated ventricular fibrillation before 12 minutes of basic life support CPR. Animals were randomized to receive either standard airway (A), breathing (B), and compression (C) CPR with expired-gas ventilation in a 15:2 compression-to-ventilation ratio or continuous chest compression CPR. Those randomized to the standard 15:2 group had no chest compressions for a period of 16 seconds each time the 2 ventilations were delivered. Defibrillation was attempted at 15 minutes of cardiac arrest. All resuscitated animals were supported in an intensive care environment for 1 hour, then in a maintenance facility for 24 hours. The primary end point of neurologically normal 24-hour survival was significantly better in the experimental group receiving continuous chest compression CPR (12 of 15 versus 2 of 15; P <0.0001). Conclusions — Mouth-to-mouth ventilation performed by single layperson rescuers produces substantial interruptions in chest compression–supported circulation. Continuous chest compression CPR produces greater neurologically normal 24-hour survival than standard ABC CPR when performed in a clinically realistic fashion. Any technique that minimizes lengthy interruptions of chest compressions during the first 10 to 15 minutes of basic life support should be given serious consideration in future efforts to improve outcome results from cardiac arrest.

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Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

et al. 2002

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“…However, return of spontaneous circulation (ROSC) is less common, occurring in Ϸ76% of these patients, and survival to hospital discharge is much lower, at 28%. 1 The mechanism(s) of myocardial dysfunction after resuscitation is poorly understood. Plasma catecholamines, an indirect measure of myocardial catecholamines, rise markedly with cardiac arrest to a level that can increase myocardial oxygen demand, aggravate myocardial ischemia, induce malignant arrhythmias, and be cytotoxic.…”

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confidence: 99%

Short-Acting β-Adrenergic Antagonist Esmolol Given at Reperfusion Improves Survival After Prolonged Ventricular Fibrillation

et al. 2004

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Background— High catecholamine concentrations are cytotoxic to cardiac myocytes. We hypothesized that myocardial interstitial catecholamine levels are greatly elevated immediately after long-duration ventricular fibrillation (VF), defibrillation, and reperfusion and that the short-acting β-antagonist esmolol administered at reperfusion would protect against this catecholamine surge and improve survival. Methods and Results— In part 1 of this study, catecholamines from myocardial interstitial fluid (ISF) and aortic and coronary sinus plasma were quantified by use of 3 H-labeled radioenzymatic assay in 8 open-chest, anesthetized pigs. Eight minutes of electrically induced VF was followed by internal defibrillation and reperfusion. By 4 minutes of VF, ISF norepinephrine increased significantly, from 1.3±0.3 to 7.4±2.4 ng/mL. Epinephrine increased significantly, from 0.4±0.2 to 1.5±0.7 ng/mL. ISF norepinephrine and epinephrine peaked at 219.2±92.1 and 63.7±25.1 ng/mL after defibrillation and reperfusion and decreased significantly to 12.2±3.5 and 6.7±3.1 ng/mL 23 minutes after defibrillation. Transcardiac catecholamine changes were similar. In part 2, 8 minutes of VF was followed by external defibrillation in anesthetized, closed-chest pigs. Animals received 1.0 mg/kg esmolol (n=8) or saline (n=8) intravenously at the start of cardiopulmonary resuscitation (CPR). Advanced cardiac life support, including CPR and epinephrine, was delivered to both groups. Esmolol before reperfusion improved return of spontaneous circulation and 4-hour survival (7/8 versus 3/8 survivors, χ 2 P <0.05). Conclusions— Transcardiac and ISF norepinephrine and epinephrine levels are briefly massively elevated after 8 minutes of VF, defibrillation, and reperfusion. A short-acting β-antagonist administered immediately after defibrillation improves return of spontaneous circulation and 4-hour survival after this prolonged VF.

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“…36 Clinical evidence that the same held true for out-of-hospital external defibrillation followed. 37 But Kouwenhoven had worked with alternating current and progressively reduced the number of cycles to oneoriginally he called it a diphasic discharge -and regarded this as optimal. Indeed, it was used in a portable defibrillator described in 1963 that could be operated using 6-or 12-volt dry batteries.…”

Section: Took a Hen Which I Knocked Down With The First Shock Dirementioning

confidence: 99%

Never quite there: a tale of resuscitation medicine

Chamberlain

2003

Clinical Medicine

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Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest Victims

Cited by 287 publications

References 38 publications

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

Short-Acting β-Adrenergic Antagonist Esmolol Given at Reperfusion Improves Survival After Prolonged Ventricular Fibrillation

Never quite there: a tale of resuscitation medicine

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