First-time evaluation of ascending compared to rectangular transthoracic defibrillation waveforms in modelled out-of-hospital cardiac arrest

Tobias Neumann; Simon-Richard Finke; Maja Henninger; Sebastian Lemke; Ben Hoepfner; Daniel Steven; Alexandra C. Maul; Daniel C. Schroeder; Thorsten Annecke

Resuscitation Plus (Mar 2020)

First-time evaluation of ascending compared to rectangular transthoracic defibrillation waveforms in modelled out-of-hospital cardiac arrest

Tobias Neumann,
Simon-Richard Finke,
Maja Henninger,
Sebastian Lemke,
Ben Hoepfner,
Daniel Steven,
Alexandra C. Maul,
Daniel C. Schroeder,
Thorsten Annecke

Affiliations

Tobias Neumann: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany; Corresponding author. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany.
Simon-Richard Finke: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany
Maja Henninger: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany
Sebastian Lemke: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany
Ben Hoepfner: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany
Daniel Steven: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Electrophysiology, Kerpener Str. 62, 50937 Cologne, Germany
Alexandra C. Maul: University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Experimental Medicine, Kerpener Str. 62, 50937 Cologne, Germany
Daniel C. Schroeder: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany
Thorsten Annecke: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group “Clinical Research and Teaching”, Kerpener Str. 62, 50937 Cologne, Germany

Journal volume & issue: Vol. 1
p. 100006

Abstract

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Aim of the study: Prognosis in out-of-hospital cardiac arrest (OHCA) depends on cardiopulmonary resuscitation (CPR) duration. Therefore, the optimal biphasic defibrillation waveform shows high conversion rates besides low energy. Matthew Fishler theoretically predicted it to be truncated ascending exponential. We realised a prototypic defibrillator and compared ascending with conventional rectangular waveforms in modelled OHCA and CPR. Methods: Approved by the authorities, 57 healthy swine (Landrace × Piétrain) were randomised to ASCDefib (n 26) or CONVDefib (n 26). Five swine served as sham control. We induced ventricular fibrillation (VF) electrically in anaesthetised swine randomised to ASCDefib or CONVDefib and discontinued mechanical ventilation. After 5 min of untreated cardiac arrest, we started CPR with mechanical chest compressions and ventilation. We performed transthoracic biphasic defibrillations after 2, 4, 6 and 8 min CPR targeting 4 J/kg in either group. Depending on the randomised group, the defibrillation protocol was either three ascending followed by one rectangular waveform (ASCDefib) or three rectangular followed by one ascending waveform (CONVDefib). Results: Under our model-specific conditions, VF was initially terminated by 13/80 ascending waveforms and 13/79 rectangular waveforms and persistent return of spontaneous circulation was achieved in 8/26 (ASCDefib) vs. 10/26 (CONVDefib) animals. Mean current rather than waveform design was predictive for defibrillation success in a generalised linear model. Conclusion: Contrary to theoretical assumptions, transthoracic biphasic defibrillation with ascending waveforms is not superior to rectangular waveforms in modelled OHCA. We advocate defibrillation dosage to be guided by current, that has proven its predictive value again. Institutional protocol number: 84–02.04.2017.A176.

Published in Resuscitation Plus

ISSN: 2666-5204 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.journals.elsevier.com/resuscitation-plus

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