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Sudden Cardiac Death, Prehospital Amiodarone Administration and Defibrillation Waveforms Tyler Cascade March 2002 tcasca PowerPoint Presentation
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Presentation Transcript
slide1
Sudden Cardiac Death,

Prehospital Amiodarone Administration and

Defibrillation Waveforms

Tyler Cascade

March 2002

tcascade@yahoo.com

slide2

Question:Is monophasic or biphasic defibrillation better, after a 300 mg IV amiodarone bolus, for the treatment of sudden cardiac death? Hypothesis 1:Monophasic is betterHypothesis 2:Biphasic is betterNull Hypotheses:The relationship between amiodarone, defibrillation threshold, and defibrillation waveforms does not affect survival after sudden cardiac death.

slide3

Mortality of Sudden Cardiac Death,

USA, 1999.

Sudden Cardiac Death (SCD) Definition:

  • unexpected
  • cardiac cause
  • short period of time from symptom onset to cardiac arrest

(Centers for Disease Control)

800,000

728,743

700,000

600,000

462,340

500,000

341,780

400,000

323,638

300,000

200,000

120,244

100,000

0

SCD Out-of-Hospital

All Cardiac Disease

SCD in ED or Dead on Arrival

Sudden Cardiac Deaths (SCD)

SCD Secondary to

myocardial infarction

slide5
Early 911 and Dispatcher Assistance

Early CPR

Early Defibrillation

Most Important

Early Drugs

Epinephrine, Vasopressin

Amiodarone, Lidocaine

Beta-Adrenergic Blockers

slide6

Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE,Hallstrom AP, Murray WA, Olsufka M, Walsh T. New England Journal of Medicine. 1999 Sep 16;341(12):871-8.

    • Survival to Hospital Admission (n=504)
    • 43% Amiodarone Group
    • 34% Placebo Group
  • Survival to Discharge
    • 13.4% Amiodarone Group
    • 13.2% Placebo Group
    • 7% Return to Independent Living or Prior Employment
external internal defibrillation waveforms currently in use
External & Internal Defibrillation Waveforms Currently In Use

MTE1- Monophasic Truncated Exponential

MDS2- Monophasic Damped Sine Wave

BTE3- Biphasic Truncated Exponential

RBW4-Rectilinear Biphasic Waveform

200, 300, 360 Joules

120, 150 Joules

slide8

Low Impedance High Impedance

50

50

40

40

30

30

20

20

10

10

0

0

-10

-10

-20

-20

0

4

8

12

0

4

8

12

Biphasic Truncated Exponential

Waveform

50

50

40

40

30

30

20

20

10

10

0

0

-10

-10

-20

-20

12

12

8

8

0

0

4

4

Rectilinear Biphasic Waveform

Current (amps)

Time (msec)

Time (msec)

3rd & 4th Generation Waveforms

Patient Impedance

Variables include:

  • Distance between electrodes (chest size)
  • Volume of air in the lungs
  • Skin properties
  • The use of conductive gels

BTE & RBW

Waveforms

50 & 150 Ohms

Impedance Compensation

120, 150 Joules

monophasic waveforms impedance
Monophasic Waveforms& Impedance

Monophasic Damped Sine Waveform (MDS)

Comparison of Waveform with 50 & 150 Ohm Impedances

2nd Generation

Figure 8

200, 300, 360 Joules

Monophasic Truncated Exponential (MTE) Waveform

Comparison of Waveform with 50 & 150 Ohm Impedances

1st Generation

Figure 4

slide10

Shortening the second phase duration of biphasic shocks: effects of class III antiarrhythmic drugs on defibrillation efficacy in humans.Merkely B; Lubinski A; Kiss O; Horkay F; Lewicka-Nowak E; Kempa M;  Szabolcs Z; Nyikos G; Zima E; Swiatecka G & Geller L.  Journal of  Cardiovascular Electrophysiology. 12(7), 824-7 (Jul 2001).Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary.

  • Effects of chronic oral amiodarone on defibrillation threshold

(Internal defibrillation)

  • Findings
    • DFT Affected by amiodarone
    • amiodarone responded differently to different waveforms
    • Optimal phase II = 2.5 ms
defibrillation threshold minimum amount of energy needed to successfully defibrillate the heart

Patient Impedance

amiodarone

Monophasic Waveforms

Biphasic Waveforms

Defibrillation ThresholdMinimum amount of energy needed to successfully defibrillate the heart