Clinical review

Reappraising the concept of immediate defibrillatory attempts for out-of-hospital ventricular fibrillation

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Despite well developed emergency medical services with rapid response advanced life support capabilities, survival rates following out-of-hospital ventricular fibrillation (VF) have remained bleak in many venues. Generally, these poor resuscitation rates are attributed to delays in the performance of basic cardiopulmonary resuscitation by bystanders or delays in defibrillation, but recent laboratory data suggest that the current standard of immediately providing a countershock as the first therapeutic intervention may be detrimental when VF is prolonged beyond several minutes. Several studies now suggest that when myocardial energy supplies begin to dwindle following more prolonged periods of VF, improvements in coronary artery perfusion must first be achieved in order to prime the heart for successful return of spontaneous circulation after defibrillation. Therefore, before countershocks, certain pharmacologic and/or mechanical interventions might take precedence during resuscitative efforts. This evolving concept has been substantiated recently by clinical studies, including a controlled clinical trial, demonstrating a significant improvement in survival when basic cardiopulmonary resuscitation is provided for several minutes before the initial countershock. Although this evolving concept differs from current standards and may pose a potential problem for automated defibrillator initiatives (e.g. public access defibrillation), successful defibrillation and return of spontaneous circulation have been rendered more predictable by evolving technologies that can score the VF waveform signal and differentiate between those who can be shocked immediately and those who should receive other interventions first.

Original languageEnglish (US)
Pages (from-to)41-45
Number of pages5
JournalCritical Care
Volume8
Issue number1
DOIs
StatePublished - Feb 2004

Fingerprint

Ventricular Fibrillation
Cardiopulmonary Resuscitation
Defibrillators
Controlled Clinical Trials
Emergency Medical Services
Resuscitation
Coronary Vessels
Perfusion
Technology
Therapeutics

Keywords

  • Advanced cardiac life support
  • Cardiac arrest
  • Cardiopulmonary arrest
  • Cardiopulmonary resuscitation
  • Countershock
  • Defibrillation
  • Median frequency
  • Resuscitation
  • Scaling exponents
  • Spectrum analysis
  • Sudden cardiac death
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

@article{a2ff5ce1e3674591bc53d9f8e561df4e,
title = "Clinical review: Reappraising the concept of immediate defibrillatory attempts for out-of-hospital ventricular fibrillation",
abstract = "Despite well developed emergency medical services with rapid response advanced life support capabilities, survival rates following out-of-hospital ventricular fibrillation (VF) have remained bleak in many venues. Generally, these poor resuscitation rates are attributed to delays in the performance of basic cardiopulmonary resuscitation by bystanders or delays in defibrillation, but recent laboratory data suggest that the current standard of immediately providing a countershock as the first therapeutic intervention may be detrimental when VF is prolonged beyond several minutes. Several studies now suggest that when myocardial energy supplies begin to dwindle following more prolonged periods of VF, improvements in coronary artery perfusion must first be achieved in order to prime the heart for successful return of spontaneous circulation after defibrillation. Therefore, before countershocks, certain pharmacologic and/or mechanical interventions might take precedence during resuscitative efforts. This evolving concept has been substantiated recently by clinical studies, including a controlled clinical trial, demonstrating a significant improvement in survival when basic cardiopulmonary resuscitation is provided for several minutes before the initial countershock. Although this evolving concept differs from current standards and may pose a potential problem for automated defibrillator initiatives (e.g. public access defibrillation), successful defibrillation and return of spontaneous circulation have been rendered more predictable by evolving technologies that can score the VF waveform signal and differentiate between those who can be shocked immediately and those who should receive other interventions first.",
keywords = "Advanced cardiac life support, Cardiac arrest, Cardiopulmonary arrest, Cardiopulmonary resuscitation, Countershock, Defibrillation, Median frequency, Resuscitation, Scaling exponents, Spectrum analysis, Sudden cardiac death, Ventricular fibrillation",
author = "Pepe, {Paul E.} and Fowler, {Raymond L.} and Roppolo, {Lynn P.} and Wigginton, {Jane G.}",
year = "2004",
month = "2",
doi = "10.1186/cc2379",
language = "English (US)",
volume = "8",
pages = "41--45",
journal = "Critical Care",
issn = "1466-609X",
publisher = "Springer Science + Business Media",
number = "1",

}

TY - JOUR

T1 - Clinical review

T2 - Reappraising the concept of immediate defibrillatory attempts for out-of-hospital ventricular fibrillation

AU - Pepe, Paul E.

AU - Fowler, Raymond L.

AU - Roppolo, Lynn P.

AU - Wigginton, Jane G.

PY - 2004/2

Y1 - 2004/2

N2 - Despite well developed emergency medical services with rapid response advanced life support capabilities, survival rates following out-of-hospital ventricular fibrillation (VF) have remained bleak in many venues. Generally, these poor resuscitation rates are attributed to delays in the performance of basic cardiopulmonary resuscitation by bystanders or delays in defibrillation, but recent laboratory data suggest that the current standard of immediately providing a countershock as the first therapeutic intervention may be detrimental when VF is prolonged beyond several minutes. Several studies now suggest that when myocardial energy supplies begin to dwindle following more prolonged periods of VF, improvements in coronary artery perfusion must first be achieved in order to prime the heart for successful return of spontaneous circulation after defibrillation. Therefore, before countershocks, certain pharmacologic and/or mechanical interventions might take precedence during resuscitative efforts. This evolving concept has been substantiated recently by clinical studies, including a controlled clinical trial, demonstrating a significant improvement in survival when basic cardiopulmonary resuscitation is provided for several minutes before the initial countershock. Although this evolving concept differs from current standards and may pose a potential problem for automated defibrillator initiatives (e.g. public access defibrillation), successful defibrillation and return of spontaneous circulation have been rendered more predictable by evolving technologies that can score the VF waveform signal and differentiate between those who can be shocked immediately and those who should receive other interventions first.

AB - Despite well developed emergency medical services with rapid response advanced life support capabilities, survival rates following out-of-hospital ventricular fibrillation (VF) have remained bleak in many venues. Generally, these poor resuscitation rates are attributed to delays in the performance of basic cardiopulmonary resuscitation by bystanders or delays in defibrillation, but recent laboratory data suggest that the current standard of immediately providing a countershock as the first therapeutic intervention may be detrimental when VF is prolonged beyond several minutes. Several studies now suggest that when myocardial energy supplies begin to dwindle following more prolonged periods of VF, improvements in coronary artery perfusion must first be achieved in order to prime the heart for successful return of spontaneous circulation after defibrillation. Therefore, before countershocks, certain pharmacologic and/or mechanical interventions might take precedence during resuscitative efforts. This evolving concept has been substantiated recently by clinical studies, including a controlled clinical trial, demonstrating a significant improvement in survival when basic cardiopulmonary resuscitation is provided for several minutes before the initial countershock. Although this evolving concept differs from current standards and may pose a potential problem for automated defibrillator initiatives (e.g. public access defibrillation), successful defibrillation and return of spontaneous circulation have been rendered more predictable by evolving technologies that can score the VF waveform signal and differentiate between those who can be shocked immediately and those who should receive other interventions first.

KW - Advanced cardiac life support

KW - Cardiac arrest

KW - Cardiopulmonary arrest

KW - Cardiopulmonary resuscitation

KW - Countershock

KW - Defibrillation

KW - Median frequency

KW - Resuscitation

KW - Scaling exponents

KW - Spectrum analysis

KW - Sudden cardiac death

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=1042304245&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1042304245&partnerID=8YFLogxK

U2 - 10.1186/cc2379

DO - 10.1186/cc2379

M3 - Article

VL - 8

SP - 41

EP - 45

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 1

ER -