Circulation, Vol 77, 1038-1046, Copyright © 1988 by American Heart Association
RE Kerber, JB Martins, MG Kienzle, L Constantin, B Olshansky, R Hopson and F Charbonnier
The purposes of this study were two. First, we wanted to evaluate in
patients a technique for automated adjustment of selected energy for
defibrillation or cardioversion based on transthoracic impedance. Second,
we wanted to define the relationship of peak current and shock success in
various arrhythmias. Applying a previously validated method of predicting
transthoracic impedance in advance of any shock, we modified defibrillators
to automatically double the operator-selected energy if the predicted
impedance exceeded 70 omega. Success rates of shocks given for ventricular
and atrial arrhythmias from these modified energy-adjusting defibrillators
were compared with success rates for shocks given from standard
defibrillators. We prospectively collected data on 347 patients who
received a total of 1009 shocks. Low-energy (100 J) shocks given to
high-impedance (greater than or equal to 70 omega) patients had a poor
success rate; in such high-impedance patients significant improvement in
shock success rate was achieved by the energy-adjusting defibrillators. For
example, when 100 J shocks were selected for high-impedance patients in
ventricular fibrillation the energy-adjusting defibrillators achieved a
shock success rate of 75%, whereas standard defibrillators achieved a shock
success rate of only 36% (p less than .01). Similar improvements were seen
for ventricular tachycardia and atrial fibrillation. Thus, automated energy
adjustment based on transthoracic impedance is a beneficial approach to
defibrillation and cardioversion. For ventricular fibrillation, atrial
fibrillation, and atrial flutter there was a clear relationship between
peak current and shock success.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Energy, current, and success in defibrillation and cardioversion: clinical studies using an automated impedance-based method of energy adjustment
Cardiovascular Division, University of Iowa, Iowa City.
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