Low‐Energy Impedance‐Compensating Biphasic Waveforms Terminate Ventricular Fibrillation at High Rates in Victims of Out‐of‐Hospital Cardiac Arrest

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Abstract
Biphasic Waveform Defibrillation. Introduction: New automatic external defibrillators (AEDs), which are smaller, lighter, easier to use, and less costly make the goal of widespread AED deployment and early defibrillation for out‐of‐hospital cardiac arrest feasible. The objective of this study was to observe the performance of a low‐energy impedance‐compensating biphasic waveform in the out‐of‐hospital setting on 100 consecutive victims of sudden cardiac arrest. Methods and Results: AEDs incorporating a 150‐J impedance‐compensating biphasic waveform were used by 12 EMS systems. Data were obtained from the AED PC card reporting system. Defibrillation was defined as conversion to an organized rhythm or to asystole. Endpoints included: defibrillation efficacy for ventricular fibrillation (VE); restoration of an organized rhythm at the time of patient transfer to an advanced life support (ALS) team or to the emergency department (ED); and time from AED power‐on to first defibrillation. The AED correctly identified 44 of 100 patients presenting in VE as requiring a shock (100% sensitivity) and 56 of 100 patients not in VF as not requiring a shock (100% specificity). The time from 911 call to first shock delivery averaged 8.1 ± 3.0 minutes. A single 150‐J biphasic shock defibrillated the initial VE episode in 39 of 44 (89%) patients. The average time from power‐on to first defibrillation was 25 ± 17 seconds. At patient transfer to ALS or ED care, an organized rhythm was present in 34 of 44 (77%) patients presenting with VF. Asystole was present in 7 (16%) and VE in 3 (7%). Conclusions: Low‐energy impedance‐compensating biphasic waveforms terminate long‐duration VE at high rates in out‐of‐hospital cardiac arrest. Use of this waveform allows AED device characteristics consistent with widespread AED deployment and early defibrillation.