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AHA ILCOR Guidelines, 2000 ; . 2 ; CHILDREN: Initial shock of 2 joules kilogram, followed by a second attempt at 2 to joules kilogram. With failure of the second shock, defibrillate a third time at 4 joules kilogram AHA ILCOR Guidelines, 2000 ; . 3 ; PREMEDICATION: According to some animal studies, when VF has been prolonged eg, 8 minutes ; , administration of high-dose epinephrine should precede electrical countershock Niemann, 1992 ; . The advantage to this is that it establishes a brief period of coronary artery perfusion. 4 ; RECURRENT VF: If ventricular fibrillation recurs during the arrest sequence, defibrillation should be reinitiated at the energy level that was previously required for successful defibrillation AHA ILCOR Guidelines, 2000 ; . b. CAUTION: Electrical arcing, fire, and burns can result. Minimize the presence of oxygen-enriched spaces in the vicinity of the paddles; apply paddles firmly ECRI, 1994 ; . c. EARLY DEFIBRILLATION: 1 ; The time to defibrillation is the major determinant of survival in cardiac arrest secondary to VF AHA ILCOR Guidelines, 2000; Nichol, 1999; Heavens, 1998 ; . Patients with VF have been found to have markedly improved survival with shorter resuscitation times Pionkowski, 1983; Kerber, 1983; AHA ILCOR Guidelines, 2000 ; . 2 ; A prospective study of adult cardiac arrests treated by both first-responders and paramedics found that the need for additional ALS other than intubation ; by the paramedics was associated with poor overall prognosis. Although aggressive ALS measures increased the number of survivors, 80% had poor neurologic outcome and 50% died within a year of discharge Callaham, 1996 ; . 3 ; The OPALS Ontario Prehospital Advanced Life Support ; study Phase II found rapid defibrillation, accomplished by multisystem changes in EMS delivery, significantly improved survival in patients with out-of-hospital cardiac arrest; a 33% relative increase in survival reported Stiell, 1999 ; . 4 ; Early defibrillation by first responders has been shown to dramatically decrease mortality and long-term neurologic sequela in patients with VF. Overall, 40% were discharged home without significant neurologic deficit following out-of-hospital treatment with automatic external defibrillators by first responders ie, police or paramedics ; White, 1998 ; . 3. DEFIBRILLATOR, AUTOMATED EXTERNAL a. FUNCTION: 1 ; The AED is a simple device that can be used by nonprofessional rescuers to treat out-of-hospital cardiac arrest; allows those with no medical skills to operate it with minimal or no training. 2 ; Adhesive electrodes are applied to sternum and apex and attached to defibrillator with flexible cables, allowing hands-free defibrillation. AED is able to monitor and analyze the cardiac rhythm and direct the operator to deliver a shock, eliminating the need for operator interpretation of rhythm AHA ILCOR Guidelines, 2000 ; . b. TYPES: Defibrillator devices that range from being "fully" automated, semiautomated, to manually operated AHA ILCOR Guidelines, 2000 ; . 1 ; FULLY AUTOMATED EXTERNAL DEFIBRILLATOR: Limited training is required. Operator must attach defibrillator pads and turn on the device; a shock will be delivered if VF or with rate greater than a preset rate is recognized. Are available only for special situations. 2 ; SEMIAUTOMATED EXTERNAL DEFIBRILLATOR: Also called a shock-advisory AED. Device automatically analyzes cardiac rhythm and then "advises" the operator to press a "shock" control to deliver the shock. Final decision to defibrillate is left to the operator. c. INDICATIONS AHA ILCOR Guidelines, 2000 ; : 1 ; An important, life-saving addition to basic life support interventions. AED use has been added to the American Heart Association and the International Liaison Committee on Resuscitation for trained lay rescuers and healthcare personnel. 2 ; Early defibrillation should be provided in the community and accomplished within 5 minutes from EMS call. 3 ; Early defibrillation also should be provided in hospital and medical facilities eg, ambulatory surgery centers defibrillation should be accomplished within 3 minutes; Class I recommendation acceptable, definitely effective ; . d. EFFICACY: 1 ; OUT-OF-HOSPITAL: a ; A study in a two-tiered urban-suburban EMS system found that use of AEDs by firstresponder EMTs did not improve survival from sudden cardiac death. These data do not support routinely equipping initial responders with AEDs as isolated enhancement and question its cost-effectiveness Sweeney, 1998 ; . 21, for example, amzryl package insert.
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