Defibrillator
CATH INTENSIVE CARE UNIT
STAFF NURSES
Definition
An electrical device used to counteract
fibrillation of the heart muscle and
restore normal heartbeat by applying a
brief electric shock
Early defibrillation is
critical to survival
• VF -frequent rhythm witnessed in SCA
• Rx for VF is electrical defibrillation
• Probability of successful defibrillation
diminishes rapidly over time
• VF tends to deteriorate to asystole within a
few minutes
For every minute that passes between
collapse and defibrillation, survival
rates from witnessed VF SCA decrease
7% to 10% if no CPR is provided
3 actions that must occur
within the 1st moment of
SCA
• Activation of the emergency medical
services (EMS) system
• Provision of CPR, and
• Operation of an AED
When 2 or more rescuers are present,
activation of EMS and initiation of CPR can
occur simultaneously
2 critical questions
about CPR+
defibrillation
• ? CPR should be provided before
defibrillation is attempted
• Number of shocks to be delivered in
a sequence before the rescuer
resumes CPR
Shock First Vs CPR First
• Out-of-hospital witnessed arrest
• If AED is immediately available
• Use the AED as soon as possible.
Shock First Vs CPR First
contd..
In hospital
CPR first
Out-of-hospital not witnessed SCA
5 cycles of CPR
Check the ECG rhythm
Defibrillation (Class IIb)
• One cycle of CPR consists of 30
compressions and 2 breaths
• When compressions are delivered at
a rate of about 100 per minute, 5
cycles of CPR should take roughly 2
minutes
This recommendation regarding CPR
prior to attempted defibrillation is
supported by 2 clinical studies
JAMA. 2003;289:1389 –1395
JAMA. 1999;281:1182–1188
1-shock Vs 3-shock sequence
• No published human studies
• Animal studies- 1 shock f/b CPR
• VF/ Pulseless VT- 1 shock f/b 5 # CPR
• Non shockable rhythm- CPR first
• 1st shock efficacy of Monophasic is lower than
biphasic shock
Defibrillation waveforms
and energy levels
• The energy settings are designed to
provide the lowest effective energy needed
to terminate VF
• Shock success -Termination of VF for at
least 5 sec following the shock
• VF frequently recurs after successful
shocks, but this recurrence should not be
equated with shock failure
• Modern defibrillators are classified as
Monophasic
Biphasic
• Energy levels vary by type of device
• No specific waveform is associated with a
higher rate of return of spontaneous
circulation (ROSC) or rates of survival to
hospital discharge after cardiac arrest
Monophasic waveform
Defibrillators
• Deliver current of one polarity
• 2 types
• The monophasic damped sinusoidal
waveform (MDS) returns to zero gradually
• Monophasic truncated exponential
waveform (MTE) current is abruptly
returned to baseline (truncated) to zero
current flow
Biphasic waveform
Defibrillators
• The optimal energy for termination
rate for VF has not been determined
• 200 J is safe and has equivalent or
higher efficacy for termination of VF
than monophasic waveform shocks of
equivalent or higher energy (Class
IIa)
Automated external
Defibrillators
• AEDs are sophisticated, reliable
devices
• Use voice and visual prompts to
guide lay rescuers and healthcare
providers to safely defibrillate VF SCA
Lay Rescuer AED
programs
• 1995 AHA recommended lay rescuer AED
programs to improve survival rates from
out-of-hospital SCA
• Studies of lay rescuer AED programs in
airports, & casinos have shown a survival
rate of 41-74% from out-of-hospital
witnessed VF SCA when immediate
bystander CPR is provided and
defibrillation occurs within about 3 to 5
minutes of collapse
Electrode placement
• Right pad – Right Infraclavicular
• Left pad – Inf-lateral left chest, lateral
to the left breast
• Position the pad at least 1 inch (2.5
cm) away from the implantable
medical device
• Do not place pads directly on top of a
transdermal medication patch
• If the victim’s chest is covered with
water or the victim is extremely
diaphoretic, wipe the chest before
attaching pads
• AEDs can be used when the victim is
lying on snow or ice
• If the victim has a hairy chest,
remove some hair
Manual Defibrillation
• Both low-energy and high-energy biphasic
waveform shocks are effective
• Both escalating & non-escalating energy
defibrillators are available
• Insufficient data to recommend one over
another
• Use device specific dose
• Biphasic- 150-200 J
• Monophasic- 360 J
• Although operator selects the shock
energy (in joules), it is the current
flow (in amperes) that actually
depolarizes the myocardium
Transthoracic
Impedance
• Human impedance is 70 to 80 Ω
• To reduce use conductive materials
• In O2 rich areas such as CCU’s arcing
has been known to cause fires
Electrode size
• Min of 50 cm2
• 8-12 cm diameter
• Small electrode mat cause
myocardial necrosis
Fire hazard
• In oxygen rich environment
• Self-adhesive minimize the risk of
sparks
• Do not use medical gels or pastes
with poor electrical conductivity, such
as ultrasound gel
Synchronized
cardioversion
• Shock delivery that is timed (synchronized)
with the QRS complex
• Avoids shock delivery during the relative
refractory portion of the cardiac cycle,
when a shock could produce VF
• Energy (shock dose) used for a
synchronized shock is lower than that used
for unsynchronized shocks (defibrillation)
• Synchronized cardioversion is
recommended to treat
• Unstable SVT
– d/t reentry
– atrial fibrillation
– atrial flutter
SVT
• Monophasic energy for A Fib = 100-
200 J
• A Flutter = 50-100 J
• If initial shock fails then increase dose in
step wise manner
• Optimal dose for biphasic waveforms
not established
• Success of terminating A fib with initial
dose = 85%
Ventricular Tachycardia
• Pulseless VT is treated as VF
Thank You
Happy Nurses
day
to all dear
nurses
