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Defibrillation and pacing during cardiac arrest 

Defibrillation and pacing during cardiac arrest
Chapter:
Defibrillation and pacing during cardiac arrest
Author(s):

Charles D. Deakin

DOI:
10.1093/med/9780199600830.003.0063
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date: 24 September 2021

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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