Pediatric transthoracic defibrillation: biphasic versus monophasic waveforms in an experimental model

Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation

“…More recent information indicates that biphasic energy waveforms are more efficacious and less toxic than monophasic waveforms in the treatment of VF (11). We and others (3)(4)(5) have demonstrated the safety and effectiveness of a pediatric dosing strategy using biphasic shocks of 50 to 86 J for the treatment of prolonged VF in piglet models. We randomized 3.4 to 27 kg piglets to treatment with pediatric doses of either monophasic 2/4/4 J/kg shocks or the same biphasic attenuated adult shock dosage used in the present study (50/75/86 J).…”

“…This attenuated dosing strategy is effective in piglet models of ventricular fibrillation (VF) (3)(4)(5). We have previously established that a pediatric defibrillation dosing strategy using attenuated adult biphasic shocks was at least as safe and effective as standard weight-based monophasic dosing in a swine model of prehospital pediatric VF (4).…”

Part 6: Electrical Therapies

“…The upper limit for safe defibrillation is also not known, but doses Ͼ4 J/kg (as high as 9 J/kg) have effectively defibrillated children 60,61 and pediatric animal models 145 with no significant adverse effects. Based on adult clinical data 21,39 and pediatric animal models, [145][146][147] biphasic shocks appear to be at least as effective as monophasic shocks and are less harmful than monophasic shocks. As noted above, it is acceptable to use an initial dose of 2 to 4 J/kg (Class IIa, LOE C), but for ease of teaching an initial dose of 2 J/kg may be considered.…”

Ventricular Fibrillation and the Use of Automated External Defibrillators on Children

“…In a study of piglets, Clark et al 42 showed that biphasic waveforms proved superior to monophasic waveforms and at lower energies in both infant and young-animal models. Although the exact energy needed for humans cannot be extrapolated from this study, the benefit of biphasic waveforms was shown.…”

“…15 Other studies [41][42][43][44][45][46] have shown also that although pediatric-attenuated shocks are ideal, including in the treatment of infants, nonattenuated adult-dosage biphasic shocks still are highly effective and relatively safe, even for a newborn infant.…”