An escalating higher energy regimen was better than a fixed lower energy regimen for defibrillation in out of hospital cardiac arrest

doi:10.1136/ebm.12.5.142

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Evidence-Based Medicine 2007;12:142; doi:10.1136/ebm.12.5.142
Copyright © 2007 by the BMJ Publishing Group Ltd.

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Therapeutics

An escalating higher energy regimen was better than a fixed lower energy regimen for defibrillation in out of hospital cardiac arrest

Stiell IG, Walker RG, Nesbitt LP, et al. BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 2007;115:1511–7.[Abstract/Free Full Text]

Q In patients with out of hospital cardiac arrest, is an escalating higher energy regimen better than a fixed lower energy regimen for arrhythmia termination with an automated external defibrillator (AED) using a biphasic waveform?

Clinical impact ratings Emergency medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Internal medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: defibrillators • electric countershock • first aid • heart arrest • ventricular fibrillation

The first 150 words of the full text of this article appear below.

METHODS
Design: randomised controlled trial.

Allocation: concealed.^*

Blinding: blinded (healthcare providers, patients, data collectors, andoutcome assessors).^*

Follow-up period: to death or hospital discharge.

Setting: out of hospital locations in 3 Canadian cities.

Patients: 221 patients $>=$ 8 years of age (mean age 66 y, 80% men) who hadout of hospital cardiac arrest and required defibrillation (forventricular fibrillation [VF] or pulseless ventricular tachycardia)and whose initial defibrillation was provided by first respondersusing an AED. Exclusion criteria included terminal illness,acute trauma, exsanguination, and not having basic cardiopulmonaryresuscitation for >10 minutes.

Intervention: the AED devices, biphasic defibrillators used by first respondingfirefighters or basic life support paramedics, were randomlyprogrammed to deliver an escalating higher energy regimen of200 J, 300 J, and 360 J with repeated shocks (n = 107) or afixed lower energy regimen of 150 J for all shocks (n = 114).The devices were . . . [Full text of this article]

Eddy S Lang, MDCM

SMBD Jewish General Hospital, McGill University,
Montreal, Quebec, Canada

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Glossary
Evid. Based Med. 2007 12: 160. (in Glossary) [Extract] [Full Text] [PDF]