(Circulation. 2000;102:1780.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
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
From Johannes Gutenberg-Universitaet (T.S., B.W.), Mainz, Germany; St Jan Hospital (P.R.M.), Brugge, Belgium; Feuerwehr Hamburg (H.P.), Hamburg, Germany; Helsinki City EMS (M.K.), Helsinki, Finland; Agilent Technologies Heartstream Operation (B.E.G., J.K.R.), Seattle, Wash; Henry Ford Hospital (W.D.W.), Detroit, Mich; University Hospital (L.B.), Antwerp, Belgium; and University of Wales College of Medicine (D.C.), Cardiff, UK.
Correspondence to Benno Wolcke, MD, Clinic of Anaesthesiology, The Johannes Gutenberg-University Medical School, Langenbeckstr 1, D-55131 Mainz, Germany. E-mail wolcke{at}mail.Uni-Mainz.de
Background—In the present study, we compared an automatic external defibrillator (AED) that delivers 150-J biphasic shocks with traditional high-energy (200- to 360-J) monophasic AEDs.
Methods and Results—AEDs were prospectively randomized according to defibrillation waveform on a daily basis in 4 emergency medical services systems. Defibrillation efficacy, survival to hospital admission and discharge, return of spontaneous circulation, and neurological status at discharge (cerebral performance category) were compared. Of 338 patients with out-of-hospital cardiac arrest, 115 had a cardiac etiology, presented with ventricular fibrillation, and were shocked with an AED. The time from the emergency call to the first shock was 8.9±3.0 (mean±SD) minutes.
Conclusions—The 150-J biphasic waveform defibrillated at higher rates, resulting in more patients who achieved a return of spontaneous circulation. Although survival rates to hospital admission and discharge did not differ, discharged patients who had been resuscitated with biphasic shocks were more likely to have good cerebral performance.
Key Words: defibrillation • resuscitation • heart arrest • heart-arrest device
This article has been cited by other articles:
 |
|
 |
|
  I. Cakulev, I. R. Efimov, and A. L. Waldo Cardioversion: Past, Present, and Future Circulation, October 20, 2009; 120(16): 1623 - 1632. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Dunning, A. Fabbri, P. H. Kolh, A. Levine, U. Lockowandt, J. Mackay, A. J. Pavie, T. Strang, M. I.M. Versteegh, S. A.M. Nashef, et al. Guideline for resuscitation in cardiac arrest after cardiac surgery Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 3 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Kajino, T Iwami, R A Berg, A Hiraide, Y Hayashi, H Yukioka, H Tanaka, T Shimazu, and H Sugimoto Comparison of neurological outcomes following witnessed out-of-hospital ventricular fibrillation defibrillated with either biphasic or monophasic automated external defibrillators Emerg. Med. J., July 1, 2009; 26(7): 492 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rosenheck, S. Gorni, I. Katz, A. Rabin, U. Shpoliansky, M. Mandelbaum, and A. T. Weiss Modified alternating current defibrillation: a new defibrillation technique Europace, February 1, 2009; 11(2): 239 - 244. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Richardson, A. Dissanayake, and J. Dunning What cardioversion protocol for ventricular fibrillation should be followed for patients who arrest shortly post-cardiac surgery? Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 799 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. R Grubb, C. Simpson, R. A Sherwood, H. D Abraha, S. M Cobbe, R. E O'Carroll, I. Deary, and K. A A Fox Prediction of cognitive dysfunction after resuscitation from out-of-hospital cardiac arrest using serum neuron-specific enolase and protein S-100 Heart, October 1, 2007; 93(10): 1268 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. H Ibrahim Recent advances and controversies in adult cardiopulmonary resuscitation Postgrad. Med. J., October 1, 2007; 83(984): 649 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ali and A. M. Zafari Narrative Review: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Review of the Current Guidelines Ann Intern Med, August 7, 2007; 147(3): 171 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Varon and P. E. Marik Cardiopulmonary Resuscitation in Patients With Cancer American Journal of Hospice and Palliative Medicine, June 1, 2007; 24(3): 224 - 229. [Abstract] [PDF]
|
|
|
|
|
|
I. G. Stiell, R. G. Walker, L. P. Nesbitt, F. W. Chapman, D. Cousineau, J. Christenson, P. Bradford, S. Sookram, R. Berringer, P. Lank, et al. BIPHASIC Trial: A Randomized Comparison of Fixed Lower Versus Escalating Higher Energy Levels for Defibrillation in Out-of-Hospital Cardiac Arrest Circulation, March 27, 2007; 115(12): 1511 - 1517. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Kudenchuk, L. A. Cobb, M. K. Copass, M. Olsufka, C. Maynard, and G. Nichol Transthoracic Incremental Monophasic Versus Biphasic Defibrillation by Emergency Responders (TIMBER): A Randomized Comparison of Monophasic With Biphasic Waveform Ascending Energy Defibrillation for the Resuscitation of Out-of-Hospital Cardiac Arrest due to Ventricular Fibrillation Circulation, November 7, 2006; 114(19): 2010 - 2018. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Tang, D. Snyder, J. Wang, L. Huang, Y.-T. Chang, S. Sun, and M. H. Weil One-Shock Versus Three-Shock Defibrillation Protocol Significantly Improves Outcome in a Porcine Model of Prolonged Ventricular Fibrillation Cardiac Arrest Circulation, June 13, 2006; 113(23): 2683 - 2689. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 American Heart Association 2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Advanced Life Support Pediatrics, May 1, 2006; 117(5): e1005 - e1028. [Full Text] [PDF]
|
|
|
|
|
|
The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Electrical Therapies: Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing Circulation, December 13, 2005; 112(24_suppl): IV-35 - IV-46. [Full Text] [PDF]
|
|
|
|
|
|
Part 12: Pediatric Advanced Life Support Circulation, December 13, 2005; 112(24_suppl): IV-167 - IV-187. [Full Text] [PDF]
|
|
|
|
|
|
Part 3: Defibrillation Circulation, November 29, 2005; 112(22_suppl): III-17 - III-24. [Full Text] [PDF]
|
|
|
|
|
|
Part 6: Pediatric Basic and Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-73 - III-90. [Full Text] [PDF]
|
|
|
|
|
|
T. D. Valenzuela, K. B. Kern, L. L. Clark, R. A. Berg, M. D. Berg, D. D. Berg, R. W. Hilwig, C. W. Otto, D. Newburn, and G. A. Ewy Interruptions of Chest Compressions During Emergency Medical Systems Resuscitation Circulation, August 30, 2005; 112(9): 1259 - 1265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kyller and D. Johnstone A 2-Tiered Approach to In-Hospital Defibrillation: Nurses Respond to a Trial of Using Automated External Defibrillators as Part of a Code-Team Protocol Crit. Care Nurse, August 1, 2005; 25(4): 25 - 33. [Full Text] [PDF]
|
|
|
|
|
|
A A J Adgey, M S Spence, and S J Walsh Theory and practice of defibrillation: (2) defibrillation for ventricular fibrillation Heart, January 1, 2005; 91(1): 118 - 125. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Zafari, S. K. Zarter, V. Heggen, P. Wilson, R. A. Taylor, K. Reddy, A. G. Backscheider, and S. C. Dudley Jr A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy J. Am. Coll. Cardiol., August 18, 2004; 44(4): 846 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Killingsworth, C.-C. Wei, L. J. Dell'Italia, J. L. Ardell, M. A. Kingsley, W. M. Smith, R. E. Ideker, and G. P. Walcott Short-Acting {beta}-Adrenergic Antagonist Esmolol Given at Reperfusion Improves Survival After Prolonged Ventricular Fibrillation Circulation, May 25, 2004; 109(20): 2469 - 2474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Tang, M. H. Weil, S. Sun, D. Jorgenson, C. Morgan, K. Klouche, and D. Snyder The effects of biphasic waveform design on post-resuscitation myocardial function J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1228 - 1235. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Wenzel, A. C. Krismer, H. R. Arntz, H. Sitter, K. H. Stadlbauer, K. H. Lindner, and the European Resuscitation Council Vasopressor dur A Comparison of Vasopressin and Epinephrine for Out-of-Hospital Cardiopulmonary Resuscitation N. Engl. J. Med., January 8, 2004; 350(2): 105 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Torok and J. Till Biphasic or monophasic defibrillation for adult ventricular fibrillation Emerg. Med. J., September 1, 2003; 20(5): 464 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Samson, R. A. Berg, and R. Bingham Use of Automated External Defibrillators for Children: An Update--An Advisory Statement From the Pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation Pediatrics, July 1, 2003; 112(1): 163 - 168. [Full Text] [PDF]
|
|
|
|
|
|
R.A. Samson, R.A. Berg, R. Bingham, D. Biarent, A. Coovadia, M.F. Hazinski, R.W. Hickey, V. Nadkarni, G. Nichol, J. Tibballs, et al. Use of Automated External Defibrillators for Children: An Update: An Advisory Statement From the Pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation Circulation, July 1, 2003; 107(25): 3250 - 3255. [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Walsh, A. Bedi, and C. Miranda Successful defibrillation in the prone position Br. J. Anaesth., November 1, 2002; 89(5): 799 - 800. [Full Text] [PDF]
|
|
|
|
|
|
A. Capucci, D. Aschieri, M. F. Piepoli, G. H. Bardy, E. Iconomu, and M. Arvedi Tripling Survival From Sudden Cardiac Arrest Via Early Defibrillation Without Traditional Education in Cardiopulmonary Resuscitation Circulation, August 27, 2002; 106(9): 1065 - 1070. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Kern, R. W. Hilwig, R. A. Berg, A. B. Sanders, and G. A. Ewy Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation: Improved Outcome During a Simulated Single Lay-Rescuer Scenario Circulation, February 5, 2002; 105(5): 645 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. Takata, R. L. Page, and J. A. Joglar Automated External Defibrillators: Technical Considerations and Clinical Promise Ann Intern Med, December 4, 2001; 135(11): 990 - 998. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-U. Strohmenger, T. Eftestol, K. Sunde, V. Wenzel, M. Mair, H. Ulmer, K. H. Lindner, and P. A. Steen The Predictive Value of Ventricular Fibrillation Electrocardiogram Signal Frequency and Amplitude Variables in Patients with Out-Of-Hospital Cardiac Arrest Anesth. Analg., December 1, 2001; 93(6): 1428 - 1433. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S Lockey and J. P Nolan Cardiopulmonary resuscitation in adults BMJ, October 13, 2001; 323(7317): 819 - 820. [Full Text] [PDF]
|
|
|
|
 |
|
 S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]
|
|
|
|
 |
|
 N. Sotoodehnia, A. Zivin, G. H Bardy, and D. S Siscovick Reducing mortality from sudden cardiac death in the community: lessons from epidemiology and clinical applications research Cardiovasc Res, May 1, 2001; 50(2): 197 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Biphasic vs. Monophasic External Defibrillation Journal Watch Emergency Medicine, December 19, 2000; 2000(1219): 3 - 3. [Full Text]
|
|