Volume 8, Issue 12 pp. 1373-1385
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Low-Energy Impedance-Compensating Biphasic Waveforms Terminate Ventricular Fibrillation at High Rates in Victims of Out-of-Hospital Cardiac Arrest

JEANNE E. POOLE M.D.

Corresponding Author

JEANNE E. POOLE M.D.

University of Washington, Seattle, Washington

Jeanne E. Poole, M.D., Division of Cardiology, Box 356422, University of Washington, 1959 N. E. Pacific St., Seattle, WA 98195. Fax: 206-616-6069; E-mail: [email protected]Search for more papers by this author
ROGER D. WHITE M.D.

ROGER D. WHITE M.D.

University of Washington, Seattle, Washington

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KARL-GEORG KANZ M.D.

KARL-GEORG KANZ M.D.

University of Washington, Seattle, Washington

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FRIEDERIKE HENGSTENBERG M.D.

FRIEDERIKE HENGSTENBERG M.D.

University of Washington, Seattle, Washington

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G. TRUETT JARRARD M.D.

G. TRUETT JARRARD M.D.

University of Washington, Seattle, Washington

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JACK C. ROBINSON

JACK C. ROBINSON

University of Washington, Seattle, Washington

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VALERIE SANTANA R.N.

VALERIE SANTANA R.N.

University of Washington, Seattle, Washington

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DAVID K. McKENAS M.D.

DAVID K. McKENAS M.D.

University of Washington, Seattle, Washington

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NATHAN RICH M.D.

NATHAN RICH M.D.

University of Washington, Seattle, Washington

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STEVEN ROSAS M.D.

STEVEN ROSAS M.D.

University of Washington, Seattle, Washington

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SALLY MERRITT

SALLY MERRITT

University of Washington, Seattle, Washington

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LUKE MAGNOTTO M.D.

LUKE MAGNOTTO M.D.

University of Washington, Seattle, Washington

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JOHN V. GALLAGHER III, M.D.

JOHN V. GALLAGHER III, M.D.

University of Washington, Seattle, Washington

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BRADFORD E. GLINER

BRADFORD E. GLINER

University of Washington, Seattle, Washington

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DAWN B. JORGENSON Ph.D.

DAWN B. JORGENSON Ph.D.

University of Washington, Seattle, Washington

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CARLTON B. MORGAN

CARLTON B. MORGAN

University of Washington, Seattle, Washington

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STEPHEN M. DILLON Ph.D.

STEPHEN M. DILLON Ph.D.

University of Washington, Seattle, Washington

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RICHARD A. KRONMAL Ph.D.

RICHARD A. KRONMAL Ph.D.

University of Washington, Seattle, Washington

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GUST H. BARDY M.D.

GUST H. BARDY M.D.

University of Washington, Seattle, Washington

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for the LIFE INVESTIGATORS

for the LIFE INVESTIGATORS

University of Washington, Seattle, Washington

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First published: 20 April 2007
Citations: 105

Dr. Bardy serves as a consultant for Heartstream, Inc.

Abstract

Biphasic Waveform Defibrillation. Introduction: New automatic external defibrillators (AEDs), which are smaller, lighter, easier to use, and less costly make the goal of widespread AED deployment and early defibrillation for out-of-hospital cardiac arrest feasible. The objective of this study was to observe the performance of a low-energy impedance-compensating biphasic waveform in the out-of-hospital setting on 100 consecutive victims of sudden cardiac arrest.

Methods and Results: AEDs incorporating a 150-J impedance-compensating biphasic waveform were used by 12 EMS systems. Data were obtained from the AED PC card reporting system. Defibrillation was defined as conversion to an organized rhythm or to asystole. Endpoints included: defibrillation efficacy for ventricular fibrillation (VE); restoration of an organized rhythm at the time of patient transfer to an advanced life support (ALS) team or to the emergency department (ED); and time from AED power-on to first defibrillation. The AED correctly identified 44 of 100 patients presenting in VE as requiring a shock (100% sensitivity) and 56 of 100 patients not in VF as not requiring a shock (100% specificity). The time from 911 call to first shock delivery averaged 8.1 ± 3.0 minutes. A single 150-J biphasic shock defibrillated the initial VE episode in 39 of 44 (89%) patients. The average time from power-on to first defibrillation was 25 ± 17 seconds. At patient transfer to ALS or ED care, an organized rhythm was present in 34 of 44 (77%) patients presenting with VF. Asystole was present in 7 (16%) and VE in 3 (7%).

Conclusions: Low-energy impedance-compensating biphasic waveforms terminate long-duration VE at high rates in out-of-hospital cardiac arrest. Use of this waveform allows AED device characteristics consistent with widespread AED deployment and early defibrillation.

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