CLINICAL STUDIES
The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function
Wanchun Tang, MD*  ,
Max Harry Weil, MD, PhD, FACC* ,
Shijie Sun, MD* ,
Hitoshi Yamaguchi, MD*,
Heitor P. Povoas, MD*,
Andreja Marn Pernat, MD* and
Joe Bisera, MSEE*
* The Institute of Critical Care Medicine, Palm Springs, California, USA
The University of Southern California School of Medicine, Los Angeles, California, USA
Manuscript received December 15, 1998;
revised manuscript received April 7, 1999,
accepted May 16, 1999.
Reprint requests and correspondence: Dr. Max Harry Weil, The Institute of Critical Care Medicine, 1695 North Sunrise Way, Building #3, Palm Springs, California 92262-5309.
weilm{at}aol.com
OBJECTIVES
The purpose of this study was to compare the effects of biphasic defibrillation waveforms and conventional monophasic defibrillation waveforms on the success of initial defibrillation, postresuscitation myocardial function and duration of survival after prolonged ventricular fibrillation (VF).
BACKGROUND
We have recently demonstrated that the severity of postresuscitation myocardial dysfunction was closely related to the magnitude of the electrical energy of the delivered defibrillation shock. In the present study, the effects of fixed 150-J low-energy biphasic waveform shocks were compared with conventional monophasic waveform shocks after prolonged VF.
METHODS
Twenty anesthetized, mechanically ventilated domestic pigs were investigated. VF was induced with an AC current delivered to the right ventricular endocardium. After either 4 or 7 min of untreated ventricular fibrillation (VF), the animals were randomized for attempted defibrillation with up to three 150-J biphasic waveform shocks or conventional sequence of 200-, 300- or 360-J monophasic waveform shocks. If VF was not reversed, a 1-min interval of precordial compression preceded a second sequence of up to three shocks. The protocol was repeated until spontaneous circulation was restored or for a total of 15 min.
RESULTS
Monophasic waveform defibrillation after 4 or 7 min of untreated VF resuscitated eight of 10 pigs. All 10 pigs treated with biphasic waveform defibrillation were successfully resuscitated. Transesophageal echo-Doppler, arterial pressure and heart rate measurements demonstrated significantly less impairment of cardiovascular function after biphasic defibrillation.
CONCLUSIONS
Lower-energy biphasic waveform shocks were as effective as conventional higher energy monophasic waveform shocks for restoration of spontaneous circulation after 4 and 7 min of untreated VF. Significantly better postresuscitation myocardial function was observed after biphasic waveform defibrillation.
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Abbreviations and Acronyms
| | CPR | = cardiopulmonary resuscitation | | EF | = ejection fraction | | FAC | = fractional area change | | FiO2 | = fractional inspired oxygen | | LVEDV | = left ventricular end-diastolic volume | | LVESV | = left ventricular end-systolic volume | | LVWD | = diastolic left ventricular posterior wall thickness | | LVWS | = systolic left ventricular posterior wall thickness | | PETCO2 | = end-tidal PCO2 | | SV | = stroke volume | | VF | = ventricular fibrillation |
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