Automated external defibrillator electrode size and termination of ventricular fibrillation in out-of-hospital cardiac arrest.

Autor: Yin RT; Stryker Emergency Care, Redmond, WA 98052, USA. Electronic address: rose.yin@stryker.com., Taylor TG; Stryker Emergency Care, Redmond, WA 98052, USA., de Graaf C; Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands., Ekkel MM; Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands., Chapman FW; Stryker Emergency Care, Redmond, WA 98052, USA., Koster RW; Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2023 Apr; Vol. 185, pp. 109754. Date of Electronic Publication: 2023 Feb 25.
DOI: 10.1016/j.resuscitation.2023.109754
Abstrakt: Smaller electrodes allow more options for design of automated external defibrillator (AED) user interfaces. However, previous studies employing monophasic-waveform defibrillators found that smaller electrode sizes have lower defibrillation shock success rates. We hypothesize that, for impedance-compensated, biphasic truncated exponential (BTE) shocks, smaller electrodes increase transthoracic impedance (TTI) but do not adversely affect defibrillation success rates. METHODS AND RESULTS: In this prospective before-and-after clinical study, Amsterdam police and firefighters used AEDs with BTE waveforms: an AED with larger electrodes in 2016-2017 (113 cm 2 ), and an AED with smaller electrodes in 2017-2020 (65 cm 2 ). We analyzed 157 and 178 patient cases with an initial shockable rhythm where the larger and smaller electrodes were used, respectively. A single 200-J shock terminated ventricular fibrillation (VF) in 86% of patients treated with large electrodes and 89% of patients treated with smaller electrodes. Small electrodes had a non-inferior first shock defibrillation success rate compared to large electrodes, with a difference of 3% (95% CI: -3% -9%) with the lower confidence limit remaining above the defined non-inferiority threshold. TTI was significantly higher for the smaller electrodes (median: 100 Ω) compared to the larger electrodes (median: 88 Ω) (p < 0.001). CONCLUSIONS: For AEDs with impedance-compensating BTE waveforms, TTI was higher for smaller electrodes than the large electrode electrodes. Overall defibrillation shock success for AEDs with smaller electrodes was non-inferior to the AEDs with larger electrodes.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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