Challenging the rationale of three sequential shocks for defibrillation

Resuscitation
Gianluca CammarataWanchun Tang

Abstract

The 2000 guidelines for cardiopulmonary resuscitation (CPR) recommend up to three sequential shocks for persistent ventricular fibrillation (VF). We hypothesized that the time consumed for repetitive rhythm analyses and recharging of the capacitor compromises the success of the second and third shock of each sequence. In 60 domestic pigs, VF was electrically induced and untreated for 7 min. After 1 min of CPR, which includes precordial compression and ventilation, up to three sequential shocks were delivered. All animals were resuscitated. For purposes of the present study we determined the outcomes of the first, the second, and the third shock of each sequence during attempted defibrillation. Our criterion of success was the restoration of spontaneous circulation (ROSC). Forty-eight of the 60 animals (80%) attained ROSC after the first shock, 9/60 (15%) after the second shock, and only 3/60 (5%) after the third shock. In confirmation of the earlier observations, ROSC was highly predictive when the coronary perfusion pressure (CPP) exceeded 12 mmHg and end-tidal CO(2) (ETCO(2)) exceeded 11 mmHg. However, these criteria were never achieved after the second shock. The present study supports the rationale of delivering only a sing...Continue Reading

References

Oct 8, 1992·The New England Journal of Medicine·I G StiellG E Dickinson
Apr 1, 1991·Annals of Emergency Medicine·L B BeckerG T Kondos
Feb 23, 1990·JAMA : the Journal of the American Medical Association·N A ParadisR M Nowak
Dec 1, 1994·American Journal of Respiratory and Critical Care Medicine·W TangJ Bisera
Mar 2, 1994·JAMA : the Journal of the American Medical Association·G LombardiP Gennis
Dec 31, 1997·Circulation·M F O'RourkeJ S Geddes
Jan 23, 1999·BMJ : British Medical Journal·J M Fielden, N S Bradbury
Apr 13, 1999·JAMA : the Journal of the American Medical Association·L A CobbA P Hallstrom
Nov 9, 2000·The New England Journal of Medicine·R L PageD K McKenas
Oct 24, 2002·The New England Journal of Medicine·Sherry L CaffreyLance B Becker
Jul 9, 2003·Critical Care Medicine·Julieta KolarovaRaúl J Gazmuri
Feb 21, 2004·Critical Care : the Official Journal of the Critical Care Forum·Paul E PepeJane G Wigginton
Aug 13, 2004·The New England Journal of Medicine·A P HallstromUNKNOWN Public Access Defibrillation Trial Investigators

❮ Previous
Next ❯

Citations

Oct 3, 2008·Current Opinion in Cardiology·Gordon A Ewy
Nov 30, 2006·Critical Care Medicine·Kathryn A Glatter
Jun 12, 2013·The Veterinary Clinics of North America. Small Animal Practice·Daniel J Fletcher, Manuel Boller
Nov 26, 2011·Journal of Critical Care·Fulvio KetteAntonino Gullo
Mar 11, 2008·Resuscitation·Charles F BabbsGary Freeman
Feb 22, 2008·Journal of Veterinary Internal Medicine·S J Plunkett, M McMichael

❮ Previous
Next ❯

Related Concepts

Related Feeds

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.