- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Part 3.1 Respiratory management
- Part 3.2 Circulatory management
- Chapter 61 Pathophysiology and causes of cardiac arrest
- Chapter 62 Cardiac massage and blood flow management during cardiac arrest
- Chapter 63 Defibrillation and pacing during cardiac arrest
- Chapter 64 Therapeutic strategies in managing cardiac arrest
- Chapter 65 Post-cardiac arrest arrhythmias
- Chapter 66 Management after resuscitation from cardiac arrest
- Chapter 67 Ethical and end-of-life issues after cardiac arrest
- Part 3.3 Fluid management
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 280) Defibrillation and pacing during cardiac arrest
- Chapter:
- (p. 280) Defibrillation and pacing during cardiac arrest
- Author(s):
Charles D. Deakin
- DOI:
- 10.1093/med/9780199600830.003.0063
Defibrillation is the passage of electrical current across the myocardium to allow synchronized repolarisation and return of a perfusing rhythm. It is now an established intervention for patients in shockable rhythms during cardiac arrest and is administered every 2 minutes during resuscitation until return of spontaneous circulation. Modern biphasic waveforms are more effective than older monophasic waveforms, achieving first shock success rate of approximately 90%. For ventricular fibrillation in adults, the initial shock should be delivered at 150 J, and if further shocks are required, escalating energy is probably more effective than a fixed energy strategy. All paediatric shocks should be delivered at 4 J/kg. Although it is important to stand clear of the patient when the shock is delivered, defibrillation should be administered with minimal interruption to resuscitation, ideally resulting in a pause to chest compressions of no more than 5 seconds. External pacing may be life-saving in patients refractory to pharmacological support of bradyarrhythmias, but is ineffective for asystole.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Part 3.1 Respiratory management
- Part 3.2 Circulatory management
- Chapter 61 Pathophysiology and causes of cardiac arrest
- Chapter 62 Cardiac massage and blood flow management during cardiac arrest
- Chapter 63 Defibrillation and pacing during cardiac arrest
- Chapter 64 Therapeutic strategies in managing cardiac arrest
- Chapter 65 Post-cardiac arrest arrhythmias
- Chapter 66 Management after resuscitation from cardiac arrest
- Chapter 67 Ethical and end-of-life issues after cardiac arrest
- Part 3.3 Fluid management
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care