Defibrillation in clinical practice.
OBJECTIVE
To discuss recent data that may influence defibrillation in clinical practice and improve outcome after cardiac arrest from a shockable rhythm.


RESULTS
Reducing the preshock pause (interval between stopping chest compressions and shock delivery) improves shock success. The preshock pause can be reduced by continuing chest compressions during defibrillator charging and using performance-integrated debriefing to improve the efficiency of the resuscitation team. The findings of a study documenting leakage current during elective cardioversion imply that the risk to healthcare personnel of accidental electrocution during defibrillation has probably been overstated. One study has shown that when more than one shock is required, a strategy of escalating defibrillation energies may be more effective than using a fixed energy. Findings from three recent studies suggest that the precordial thump is ineffective for terminating ventricular fibrillation or ventricular tachycardia.


CONCLUSIONS
A defibrillation strategy that enables rhythm analysis to recognize ventricular fibrillation, defibrillator charging and optimally timed shock delivery with minimal or no interruptions to chest compressions should improve the chances of shock success. Performance debriefing of rescuers and recognizing that the risk to rescuers during defibrillation has been overstated should also help minimize interruptions to chest compressions for shock delivery.
Nolan
Jerry P
JP
Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Combe Park, Bath BA1 3NG, UK. jerry.nolan@ruh.nhs.uk
Soar
Jasmeet
J
D016887:Cardiopulmonary Resuscitation / Q000379:methods; D035641:Chest Wall Oscillation; D004554:Electric Countershock / Q000379:methods*; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy