Energy Waveforms and Dosing
Because first shock efficacy for monophasic shocks is lower than first shock efficacy for biphasic shocks, the AHA 2005 Guidelines recommend different initial shock dosages for monophasic defibrillators (360 Joules [J]) and biphasic defibrillators (150-200J). The Guidelines also recommend subsequent biphasic doses at "equal or higher" energy settings.
Clinical evidence shows the limitations of 200J and the benefits of having full energy biphasic available. A recent out-of-hospital study showed that when energy dosage is limited to 200J biphasic, up to 12% of patients will fail to defibrillate. A separate large out-of-hospital study showed that availability of higher dosage (up to 360J) was associated with a much lower rate of failure (just 0.5% of 416 patients) and good survival (27%).
Challenges
- Will your responders always know which kind of device they are using-monophasic or biphasic?
- Will they be familiar with the appropriate protocol for either type of technology?
- Do your defibrillators provide higher dosage-beyond 200J-for difficult-to-treat patients?
Meeting the Challenges
By standardizing your service with the LIFEPAK® family of defibrillators you can proactively address each of these challenges. LIFEPAK defibrillators use ADAPTIV™ biphasic technology, giving you a full range of energy dosing up to 360J and a dosing protocol that many responders are already familiar with from the traditional monophasic protocols.