Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 Yes, the manufacturer recommendations are to use escalating energy settings, starting at 200 first shock, 300 second, 360 third and all subsequent. ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of rems510 Sent: Wednesday, July 30, 2008 11:12 AM To: texasems-l Subject: Biphasic monitors I recently found out that one of our LP 12 monitors is a biphasic defib. with the capability of charging to 360 joules of biphasic energy. My question is; If we start at 200 joules and do not get the expected response, should we increase the energy to 300 joules then 360 joules. Of course I am assuming this would be patient specific, i.e. large person, morbidly obese. Anyone with some input or answer please let me know. Thanks, ez NREMT-P Director-Robstown EMS *********************************************************************** This electronic transmission contains information from Methodist Health System and should be considered confidential and privileged. The information contained in the above messages is intended only for the use of the individual(s) and entity(ies) named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution, or use of this information is prohibited. If you receive this transmission in error, please notify the sender immediately by return e-mail. Methodist Health System, its subsidiaries and affiliates hereby claim all applicable privileges related to the transmission of this communication. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 I have had this conversation too, the AHA pretty much says you don't need to escalate the energy settings but if you talk to MedTronics techs they still say that the MedTronics stance is to escalate to 360j. So to answer your question I don't know what the correct answer is or how any of us would fair in court as to what the standard of care is. Lee From: texasems-l [mailto:texasems-l ] On Behalf Of rems510 Sent: Wednesday, July 30, 2008 11:12 AM To: texasems-l Subject: Biphasic monitors I recently found out that one of our LP 12 monitors is a biphasic defib. with the capability of charging to 360 joules of biphasic energy. My question is; If we start at 200 joules and do not get the expected response, should we increase the energy to 300 joules then 360 joules. Of course I am assuming this would be patient specific, i.e. large person, morbidly obese. Anyone with some input or answer please let me know. Thanks, ez NREMT-P Director-Robstown EMS Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 Actually, the recommended initial defib setting from the AHA is device-specific. For truncated exponential waveforms such as the one used in the LP12, the recommended energy setting is 150 joules. No need to increase the setting for second and subsequent shocks. rems510 wrote: > > I recently found out that one of our LP 12 monitors is a biphasic defib. > with the capability of charging to 360 joules of biphasic energy. > My question is; If we start at 200 joules and do not get the expected > response, should we increase the energy to 300 joules then 360 joules. > Of course I am assuming this would be patient specific, i.e. large > person, morbidly obese. Anyone with some input or answer please let me > know. > > Thanks, > ez NREMT-P > Director-Robstown EMS > -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 Is anyone having problems with their LP 12's and the reps? ____________________________________________________________ Save on Emergency Alert Systems. Click here. http://thirdpartyoffers.juno.com/TGL2131/fc/Ioyw6iiexRVNJwMGVyeI5xVE3DPSLxmxcGJ2\ rNKl4vdW5k97LdLcz5/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 We have received our monitors and all associated equipment with a little delay but all has been received, they are working great. Â Eddie EMS Coordinator -- Crockett County EMS PO Box 577 Ozona, Texas 76943 w. c. f. Re: Biphasic monitors Is anyone having problems with their LP 12's and the reps? ____________ _________ _________ _________ _________ _________ _ Save on Emergency Alert Systems. Click here. http://thirdpartyof fers.juno. com/TGL2131/ fc/Ioyw6iiexRVNJ wMGVyeI5xVE3DPSL xmxcGJ2rNKl4vdW5 k97LdLcz5/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 , You certain about this...I thought (I know...danger will robinson) that only Zoll was the ones set on low energy as the answer...hence why their machine doesn't go to 360 anymore... Dudley Re: Biphasic monitors Actually, the recommended initial defib setting from the AHA is device-specific. For truncated exponential waveforms such as the one used in the LP12, the recommended energy setting is 150 joules. No need to increase the setting for second and subsequent shocks. rems510 wrote: > > I recently found out that one of our LP 12 monitors is a biphasic defib. > with the capability of charging to 360 joules of biphasic energy. > My question is; If we start at 200 joules and do not get the expected > response, should we increase the energy to 300 joules then 360 joules. > Of course I am assuming this would be patient specific, i.e. large > person, morbidly obese. Anyone with some input or answer please let me > know. > > Thanks, > ez NREMT-P > Director-Robstown EMS > -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 also makes low energy biphasic defibrillators. The energy settings at least with Zoll are customized according to the chest impedance of the patient. Waveform is slightly different between brands. Lt. Steve Lemming, A.A.S., L.P. C-Shift EMS Administration Officer Azle, Texas Fire Department This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of The City of Azle or its policies. If you have received this e-mail message in error, please phone Steve Lemming (817)444-7108. Please also destroy and delete the message from your computer. For more information on The City of Azle, visit our web site at: http://www.cityofazle.org <http://www.cityofazle.org> From: texasems-l [mailto:texasems-l ] On Behalf Of THEDUDMAN@... Sent: Wednesday, July 30, 2008 8:24 PM To: texasems-l Subject: Re: Biphasic monitors , You certain about this...I thought (I know...danger will robinson) that only Zoll was the ones set on low energy as the answer...hence why their machine doesn't go to 360 anymore... Dudley Re: Biphasic monitors Actually, the recommended initial defib setting from the AHA is device-specific. For truncated exponential waveforms such as the one used in the LP12, the recommended energy setting is 150 joules. No need to increase the setting for second and subsequent shocks. rems510 wrote: > > I recently found out that one of our LP 12 monitors is a biphasic defib. > with the capability of charging to 360 joules of biphasic energy. > My question is; If we start at 200 joules and do not get the expected > response, should we increase the energy to 300 joules then 360 joules. > Of course I am assuming this would be patient specific, i.e. large > person, morbidly obese. Anyone with some input or answer please let me > know. > > Thanks, > ez NREMT-P > Director-Robstown EMS > -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 We use monitors in our service, I don't have one in front of me, but I believe the adult dose (clearly marked on the monitor) is 150J... Joe Percer, LP On Wed, Jul 30, 2008 at 10:57 PM, Lemming, Steve wrote: > also makes low energy biphasic defibrillators. The energy > settings at least with Zoll are customized according to the chest > impedance of the patient. Waveform is slightly different between brands. > > Lt. Steve Lemming, A.A.S., L.P. > > C-Shift > > EMS Administration Officer > > Azle, Texas Fire Department > > This e-mail is confidential and intended solely for the use of the > individual (s) to whom it is addressed. Any views or opinions presented > are solely those of the author and do not necessarily represent those of > The City of Azle or its policies. If you have received this e-mail > message in error, please phone Steve Lemming (817)444-7108. Please also > destroy and delete the message from your computer. > > For more information on The City of Azle, visit our web site at: > http://www.cityofazle.org <http://www.cityofazle.org> > > From: texasems-l <texasems-l%40yahoogroups.com> [mailto: > texasems-l <texasems-l%40yahoogroups.com>] On > Behalf Of THEDUDMAN@... <THEDUDMAN%40aol.com> > Sent: Wednesday, July 30, 2008 8:24 PM > To: texasems-l <texasems-l%40yahoogroups.com> > Subject: Re: Biphasic monitors > > , > > You certain about this...I thought (I know...danger will robinson) that > only Zoll was the ones set on low energy as the answer...hence why their > machine doesn't go to 360 anymore... > > Dudley > > Re: Biphasic monitors > > Actually, the recommended initial defib setting from the AHA is > device-specific. For truncated exponential waveforms such as the one > used in the LP12, the recommended energy setting is 150 joules. No need > to increase the setting for second and subsequent shocks. > > rems510 wrote: > > > > I recently found out that one of our LP 12 monitors is a biphasic > defib. > > with the capability of charging to 360 joules of biphasic energy. > > My question is; If we start at 200 joules and do not get the expected > > response, should we increase the energy to 300 joules then 360 joules. > > Of course I am assuming this would be patient specific, i.e. large > > person, morbidly obese. Anyone with some input or answer please let me > > know. > > > > Thanks, > > ez NREMT-P > > Director-Robstown EMS > > > > -- > Grayson, CCEMT-P > www.kellygrayson.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 Yes, you're right. It's 150. I just spent the evening training medic students on it. On the energy dial, it's clearly marked as the adult dose. GG > > We use monitors in our service, I don't have one in front of me, > but I believe the adult dose (clearly marked on the monitor) is 150J... > > Joe Percer, LP > > On Wed, Jul 30, 2008 at 10:57 PM, Lemming, Steve <slemming@...@c> > wrote: > > > also makes low energy biphasic defibrillators. The energy > > settings at least with Zoll are customized according to the chest > > impedance of the patient. Waveform is slightly different between brands. > > > > Lt. Steve Lemming, A.A.S., L.P. > > > > C-Shift > > > > EMS Administration Officer > > > > Azle, Texas Fire Department > > > > This e-mail is confidential and intended solely for the use of the > > individual (s) to whom it is addressed. Any views or opinions presented > > are solely those of the author and do not necessarily represent those of > > The City of Azle or its policies. If you have received this e-mail > > message in error, please phone Steve Lemming (817)444-7108. Please also > > destroy and delete the message from your computer. > > > > For more information on The City of Azle, visit our web site at: > > http://www.cityofazhttp:/ <http://www.cityofazhttp:/> > > > > From: texasems-l@yahoogrotexasem <texasems-l%texasems-l%<wbtex> [mailto: > > texasems-l@yahoogrotexasem <texasems-l%texasems-l%<wbtex>] On > > Behalf Of THEDUDMAN@... <THEDUDMAN%40aol.THE> > > Sent: Wednesday, July 30, 2008 8:24 PM > > To: texasems-l@yahoogrotexasem <texasems-l%texasems-l%<wbtex> > > Subject: Re: Biphasic monitors > > > > , > > > > You certain about this...I thought (I know...danger will robinson) that > > only Zoll was the ones set on low energy as the answer...hence why their > > machine doesn't go to 360 anymore... > > > > Dudley > > > > Re: Biphasic monitors > > > > Actually, the recommended initial defib setting from the AHA is > > device-specific. For truncated exponential waveforms such as the one > > used in the LP12, the recommended energy setting is 150 joules. No need > > to increase the setting for second and subsequent shocks. > > > > rems510 wrote: > > > > > > I recently found out that one of our LP 12 monitors is a biphasic > > defib. > > > with the capability of charging to 360 joules of biphasic energy. > > > My question is; If we start at 200 joules and do not get the expected > > > response, should we increase the energy to 300 joules then 360 joules. > > > Of course I am assuming this would be patient specific, i.e. large > > > person, morbidly obese. Anyone with some input or answer please let me > > > know. > > > > > > Thanks, > > > ez NREMT-P > > > Director-Robstown EMS > > > > > > > -- > > Grayson, CCEMT-P > > www.kellygrayson. ww > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 " You certain about this...I thought (I know...danger will robinson) that only Zoll was the ones set on low energy as the answer...hence why their machine doesn't go to 360 anymore... " Fairly certain, Dudley. The *AHA* recommends a fixed energy setting , and no escalating doses. The recommended dose is device specific: For truncated exponential waveforms (Physio), use 150 joules. For phased pulse rectilinear waveforms (Zoll) use 120 joules. All others, use 200 joules. Now, that may differ from the *manufacturers* recommendations, as someone else has pointed out that it does with the Physio products. -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2008 Report Share Posted August 28, 2008 Read these and let me know what everyone thinks..... Subject: Re: Biphasic monitors To: texasems-l Date: Thursday, July 31, 2008, 8:46 AM " You certain about this...I thought (I know...danger will robinson) that only Zoll was the ones set on low energy as the answer...hence why their machine doesn't go to 360 anymore... " Fairly certain, Dudley. The *AHA* recommends a fixed energy setting , and no escalating doses. The recommended dose is device specific: For truncated exponential waveforms (Physio), use 150 joules. For phased pulse rectilinear waveforms (Zoll) use 120 joules. All others, use 200 joules. Now, that may differ from the *manufacturers* recommendations, as someone else has pointed out that it does with the Physio products. -- Grayson, CCEMT-P www.kellygrayson. com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 Not sure what you are asking Chris. As far as below, Philips also uses low energy although it is a slightly different waveform than the other low energy defibs. At last check the AHA had both high and low energy recommendations in their guidelines. It seems to be that they don't wish to pit one version against another for fear of litigation from the manufacturers not recommended. There are studies on both sides of the low and high energy fence that show efficacy. Discussing defibrillators is one of those never ending discussions or arguments. Each person has their own opinion and will defend it fiercely. My own take is that a customization of energy setting according to chest impedance probably makes sense. The only thing we know for sure is that monophasic defibrillation is out. Lt. Steve Lemming, A.A.S., L.P. C-Shift EMS Administration Officer Azle, Texas Fire Department This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of The City of Azle or its policies. If you have received this e-mail message in error, please phone Steve Lemming (817)444-7108. Please also destroy and delete the message from your computer. For more information on The City of Azle, visit our web site at: http://www.cityofazle.org <http://www.cityofazle.org> From: texasems-l [mailto:texasems-l ] On Behalf Of Weinzapfel Sent: Thursday, August 28, 2008 2:03 PM To: texasems-l Subject: Re: Biphasic monitors Read these and let me know what everyone thinks..... From: Grayson <Grayson902@... <mailto:Grayson902%40aol.com> > Subject: Re: Biphasic monitors To: texasems-l <mailto:texasems-l%40yahoogroups.com> Date: Thursday, July 31, 2008, 8:46 AM " You certain about this...I thought (I know...danger will robinson) that only Zoll was the ones set on low energy as the answer...hence why their machine doesn't go to 360 anymore... " Fairly certain, Dudley. The *AHA* recommends a fixed energy setting , and no escalating doses. The recommended dose is device specific: For truncated exponential waveforms (Physio), use 150 joules. For phased pulse rectilinear waveforms (Zoll) use 120 joules. All others, use 200 joules. Now, that may differ from the *manufacturers* recommendations, as someone else has pointed out that it does with the Physio products. -- Grayson, CCEMT-P www.kellygrayson. com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 Lemming, Steve wrote: > > " Discussing defibrillators is one of those never ending discussions or > arguments. Each person has their own opinion and will defend it > fiercely. " > > . > > Bet my monitor can beat up your monitor. -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 Exactly. From: texasems-l [mailto:texasems-l ] On Behalf Of Grayson Sent: Friday, August 29, 2008 9:33 AM To: texasems-l Subject: Re: Biphasic monitors Lemming, Steve wrote: > > " Discussing defibrillators is one of those never ending discussions or > arguments. Each person has their own opinion and will defend it > fiercely. " > > . > > Bet my monitor can beat up your monitor. -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 I suggest that you go with the manufacturer's recommendation, which in the case of Philips is 150, if you don't want to be explaining to a jury why you deviated from the manufacturer's advice. GG > > Not sure what you are asking Chris. As far as below, Philips also uses > low energy although it is a slightly different waveform than the other > low energy defibs. > > At last check the AHA had both high and low energy recommendations in > their guidelines. It seems to be that they don't wish to pit one version > against another for fear of litigation from the manufacturers not > recommended. There are studies on both sides of the low and high energy > fence that show efficacy. > > Discussing defibrillators is one of those never ending discussions or > arguments. Each person has their own opinion and will defend it > fiercely. My own take is that a customization of energy setting > according to chest impedance probably makes sense. > > The only thing we know for sure is that monophasic defibrillation is > out. > > Lt. Steve Lemming, A.A.S., L.P. > > C-Shift > > EMS Administration Officer > > Azle, Texas Fire Department > > This e-mail is confidential and intended solely for the use of the > individual (s) to whom it is addressed. Any views or opinions presented > are solely those of the author and do not necessarily represent those of > The City of Azle or its policies. If you have received this e-mail > message in error, please phone Steve Lemming (817)444-7108. Please also > destroy and delete the message from your computer. > > For more information on The City of Azle, visit our web site at: > http://www.cityofazhttp:/ <http://www.cityofazhttp:/> > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of Weinzapfel > Sent: Thursday, August 28, 2008 2:03 PM > To: texasems-l@yahoogrotexasem > Subject: Re: Biphasic monitors > > Read these and let me know what everyone thinks..... > > > > From: Grayson <Grayson902@... <mailto:Grayson902%mailto:Gr> > > Subject: Re: Biphasic monitors > To: texasems-l@yahoogrotexasem <mailto:texasems-mailto:texasems-mai> > Date: Thursday, July 31, 2008, 8:46 AM > > " You certain about this...I thought (I know...danger will robinson) that > > only Zoll was the ones set on low energy as the answer...hence why their > > machine doesn't go to 360 anymore... " > > Fairly certain, Dudley. > > The *AHA* recommends a fixed energy setting , and no escalating doses. > The recommended dose is device specific: For truncated exponential > waveforms (Physio), use 150 joules. For phased pulse rectilinear > waveforms (Zoll) use 120 joules. All others, use 200 joules. > > Now, that may differ from the *manufacturers* recommendations, as > someone else has pointed out that it does with the Physio products. > > -- > Grayson, CCEMT-P > www.kellygrayson. com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 >>> The only thing we know for sure is that monophasic defibrillation is out. <<< Steve, That having been said, here is some interesting data on their efficacy . . . (yes, I know it is retrospective, but I find it interesting nonetheless.) Freeman K, Hendey GW, Shalit M, Stroh G. Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2008 Apr-Jun;12 (2):152-6. STUDY OBJECTIVE: To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. METHODS: We conducted a retrospective review of electronic prehospital and hospital records for victims of OHCA between August 2000 and July 2004, including two years before and after implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, and discharge to home versus an extended care facility. RESULTS: There were 485 cases of cardiac arrest included. Baseline characteristics between the monophasic and biphasic groups were similar. ROSC was achieved in 77 (30.6%, 95% CI 25.2-36.5%) of 252 patients in the monophasic group, and in 70 (30.0% 95% CI 24.5-36.2%) of 233 in the biphasic group (p = .92). Survival to hospital discharge was 12.3% (95% CI 8.8-17%) for monophasic and 10.3% (95% CI 7.0-14.9%) for biphasic (p = .57). Discharge to home was accomplished in 20 (7.9%, 95% CI 5.1-12.0%) of the monophasic, and in 15 (6.4%, 95% CI 3.9-10.4%) of the biphasic group (p = .60). More defibrillations were required to achieve ROSC (3.5 vs. 2.6, p = .015) in the monophasic group. CONCLUSIONS: We found no difference in ROSC or survival to hospital discharge between MTE and BTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation. What I think this means is that there are many factors that influence the successful outcome of out-of-hospital cardiac arrest (this review was not designed to address those influences). Until we (in EMS) get handle on those other issues (quality of CPR, for example), we can shock them with anything we want and it isn't going to produce an greater number of survivors (statistically speaking). Kenny Navarro Dallas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 Kenny. I agree with you. We try everything we can, throw every new drug and gadget at the problem, and we still can't get large numbers of this group to exit the hospital upright. Many of these are catastrophic cardiac events that would be fatal regardless of what we used on them. All we can do is use the studies available to evaluate what we do and make the necessary changes until we get the optimal outcome. Thanks for providing a balance in the discussion. Lt. Steve Lemming, A.A.S., L.P. C-Shift EMS Administration Officer Azle, Texas Fire Department This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of The City of Azle or its policies. If you have received this e-mail message in error, please phone Steve Lemming (817)444-7108. Please also destroy and delete the message from your computer. For more information on The City of Azle, visit our web site at: http://www.cityofazle.org <http://www.cityofazle.org> From: texasems-l [mailto:texasems-l ] On Behalf Of Kenny Navarro Sent: Friday, August 29, 2008 5:50 PM To: texasems-l Subject: Re: Biphasic monitors >>> The only thing we know for sure is that monophasic defibrillation is out. <<< Steve, That having been said, here is some interesting data on their efficacy . . . (yes, I know it is retrospective, but I find it interesting nonetheless.) Freeman K, Hendey GW, Shalit M, Stroh G. Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2008 Apr-Jun;12 (2):152-6. STUDY OBJECTIVE: To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. METHODS: We conducted a retrospective review of electronic prehospital and hospital records for victims of OHCA between August 2000 and July 2004, including two years before and after implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, and discharge to home versus an extended care facility. RESULTS: There were 485 cases of cardiac arrest included. Baseline characteristics between the monophasic and biphasic groups were similar. ROSC was achieved in 77 (30.6%, 95% CI 25.2-36.5%) of 252 patients in the monophasic group, and in 70 (30.0% 95% CI 24.5-36.2%) of 233 in the biphasic group (p = .92). Survival to hospital discharge was 12.3% (95% CI 8.8-17%) for monophasic and 10.3% (95% CI 7.0-14.9%) for biphasic (p = .57). Discharge to home was accomplished in 20 (7.9%, 95% CI 5.1-12.0%) of the monophasic, and in 15 (6.4%, 95% CI 3.9-10.4%) of the biphasic group (p = .60). More defibrillations were required to achieve ROSC (3.5 vs. 2.6, p = .015) in the monophasic group. CONCLUSIONS: We found no difference in ROSC or survival to hospital discharge between MTE and BTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation. What I think this means is that there are many factors that influence the successful outcome of out-of-hospital cardiac arrest (this review was not designed to address those influences). Until we (in EMS) get handle on those other issues (quality of CPR, for example), we can shock them with anything we want and it isn't going to produce an greater number of survivors (statistically speaking). Kenny Navarro Dallas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2008 Report Share Posted August 29, 2008 Steve Lemming wrote " we still can't get large numbers of this group to exit the hospital upright. " Perhaps one lesson from my very first EMS certification class in 1981 where Dr. Jack Love Medical Director of Underwood-Memorial's ED said " the only constant in this business is some people die but that's also a rule of life since everyone dies " . It took me about 3 months after I hit the street to really grasp that point and at that moment an EMS cynic was born at 17. LNM from Baku, Azerbaijan Sent via BlackBerry by AT & T Re: Biphasic monitors >>> The only thing we know for sure is that monophasic defibrillation is out. <<< Steve, That having been said, here is some interesting data on their efficacy . . . (yes, I know it is retrospective, but I find it interesting nonetheless.) Freeman K, Hendey GW, Shalit M, Stroh G. Biphasic defibrillation does not improve outcomes compared to monophasic defibrillation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2008 Apr-Jun;12 (2):152-6. STUDY OBJECTIVE: To compare the outcomes of out-of hospital cardiac arrest (OHCA) victims treated with monophasic truncated exponential (MTE) versus biphasic truncated exponential (BTE) defibrillation in an urban EMS system. METHODS: We conducted a retrospective review of electronic prehospital and hospital records for victims of OHCA between August 2000 and July 2004, including two years before and after implementation of biphasic defibrillators by the Fresno County EMS agency. Main outcome measures included: return of spontaneous circulation (ROSC), number of defibrillations required for ROSC, survival to hospital discharge, and discharge to home versus an extended care facility. RESULTS: There were 485 cases of cardiac arrest included. Baseline characteristics between the monophasic and biphasic groups were similar. ROSC was achieved in 77 (30.6%, 95% CI 25.2-36.5%) of 252 patients in the monophasic group, and in 70 (30.0% 95% CI 24.5-36.2%) of 233 in the biphasic group (p = .92). Survival to hospital discharge was 12.3% (95% CI 8.8-17%) for monophasic and 10.3% (95% CI 7.0-14.9%) for biphasic (p = .57). Discharge to home was accomplished in 20 (7.9%, 95% CI 5.1-12.0%) of the monophasic, and in 15 (6.4%, 95% CI 3.9-10.4%) of the biphasic group (p = .60). More defibrillations were required to achieve ROSC (3.5 vs. 2.6, p = .015) in the monophasic group. CONCLUSIONS: We found no difference in ROSC or survival to hospital discharge between MTE and BTE defibrillation in the treatment of OHCA, although fewer defibrillations were required to achieve ROSC in those treated with biphasic defibrillation. What I think this means is that there are many factors that influence the successful outcome of out-of-hospital cardiac arrest (this review was not designed to address those influences). Until we (in EMS) get handle on those other issues (quality of CPR, for example), we can shock them with anything we want and it isn't going to produce an greater number of survivors (statistically speaking). Kenny Navarro Dallas Quote Link to comment Share on other sites More sharing options...
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