Br 3021 Shock Manual

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Br 3021 Shock Manual

Automatic external defibrillators that provide an audible signal of the success of a shock, with a reasonable delay after the shock, should be in common use in health systems with AED programs.

Although a recent theoretical model predicts that the probability of successful defibrillation increases with increasing shock dose when defibrillation is attempted within 3 minutes of the onset of VF, there is inadequate evidence to confirm or refute these predictions. (LOE 7 11,1121 )

There are insufficient data to recommend for or against the use of a time-limited break in CPR to allow analysis of the ECG rhythm by a bystander who may apply a defibrillator. The use of a break in CPR should be considered when bystanders are the first to initiate CPR on a patient with an unexpectedly arising arrest and are, for any reason, unable to evaluate the patient’s rhythm or perform CPR well. If defibrillation is required within 3 minutes of the first shock, no time-limited break in CPR should be used.

In the review of initial CPR by Seal in 2001, immediate shocks were used in 112 of 342 cases (32.6%). Of these immediate shocks, 49 (44.1%) were delivered between 10 and 50 seconds after CPR was initiated and 63 (55.9%) were delivered within 5 minutes of arrest. No device, dose, or protocol was associated with improved outcome. For initial CPR, the current recommendation is to use a 3-mg dose of epinephrine, delivered at the same time as or close to the time of defibrillation. 56,59

The goal of ALS therapy is to maximize ROSC and minimize the delay in shock delivery. Patients with VF are most likely to be shocked at least once during the resuscitation. 63,70,71,75,76 The number of shocks delivered has been associated with clinical outcome. 22,63,78

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