title: Treatment of out-of-hospital cardiac arrest with a low-energy impedance-compensating biphasic waveform automatic external defibrillator. The LIFE Investigators.
abstract: Few victims of sudden cardiac arrest survive. A new generation of automatic external defibrillators (AEDs), smaller, lighter, easier to use, and less costly, makes the goal of widespread AED deployment and early defibrillation feasible. A low-energy impedance-compensating biphasic waveform allows AED device characteristics more suitable to the goal of early defibrillation than high-energy waveforms. This study observed the performance of such a biphasic waveform in the out-of-hospital setting on 100 consecutive victims of sudden cardiac arrest treated by a wide range of first-responders. AEDs incorporating 150-J impedance-compensating biphasic waveforms were placed into service of 34 EMS systems. Data were obtained from the AED PC data card-recording system. The first endpoint was to determine the effectiveness of this waveform in terminating ventricular fibrillation (VF). The second endpoint was to determine whether or not the use of such an AED culminated in an organized rhythm at the time of patient transfer to an advanced life support (ALS) team or emergency department (ED). The third endpoint was to assess the efficiency of the human-factors design of the AED by measuring user time intervals. The 34 sites provided data from 286 consecutive AED uses, 100 from SCA victims with VF as their initial rhythm upon attachment of the AED. All 286 patients were correctly identified by the AED as requiring a shock (100% sensitivity for the 100 VF patients) or not (100% specificity to the 186 patients not presenting in VF). Times from emergency call to first shock delivery averaged 9.1 +/- 7.3 minutes. A single 150-J biphasic shock defibrillated the initial VF episode in 86% of patients. For all 450 episodes of VF in these 100 patients, an average of 86% +/- 24% of VF episodes were terminated with a single biphasic shock. Of the 449 VF episodes that received up to three shocks, 97% +/- 11% were terminated with three shocks or fewer. The average number of shocks per VF episode was 1.3 +/- 0.7. The average time from AED power-on and pads attached to first defibrillation was 25 +/- 23 sec. At the time of patient transfer, an organized rhythm was present in 65% of the VF patients; asystole was the result in 25%, and VF was in progress in 10%. It is concluded that low-energy impedance-compensating biphasic waveforms terminate long-duration VF at high rates in out-of-hospital cardiac arrest and provide defibrillation rates exceeding those previously achieved with high-energy shocks. Use of this waveform allows AED device characteristics consistent with widespread AED deployment and early defibrillation.
authors.affiliation: Heartstream, Inc., Seattle, WA 98121, USA. GlinerB@heartstream.com
authors.forename: B E
authors.initials: BE
authors.lastname: Gliner
authors.forename: D B
authors.initials: DB
authors.lastname: Jorgenson
authors.forename: J E
authors.initials: JE
authors.lastname: Poole
authors.forename: R D
authors.initials: RD
authors.lastname: White
authors.forename: K G
authors.initials: KG
authors.lastname: Kanz
authors.forename: T D
authors.initials: TD
authors.lastname: Lyster
authors.forename: K W
authors.initials: KW
authors.lastname: Leyde
authors.forename: D J
authors.initials: DJ
authors.lastname: Powers
authors.forename: C B
authors.initials: CB
authors.lastname: Morgan
authors.forename: R A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: G H
authors.initials: GH
authors.lastname: Bardy
mesh_terms: D001331:Automation / Q000295:instrumentation; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods; D004558:Electric Stimulation; D004562:Electrocardiography; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy*