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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2000 January-February;66(1-2):45-53

language: English

Biphasic waveforms for automatic external defibrillation in human: a review

Di Massa A. *, Scardigli M., Bruni L., Valentino L.

From the Sezione Terapia del Dolore
*Dipartimento di Scienze Odontostomatologiche Istituto di Anestesiologia e Rianimazione Università degli Studi - Siena


Ventricular fib­ril­la­tion is the prin­ci­pal ­cause of sud­den car­diac arrest and the electrical defibrillation is often the only effective therapy. A very interesting question is represented by the electric parameters of defibrillation shock. Today, mono­phas­ic wave­form is wide­ly ­used in Europe and in the United States, but, recent­ly, the Food and Drug Administration ­grants approv­al for an auto­mat­ic exter­nal defib­ril­la­tor (AED) pro­duc­ing a biphas­ic ­pulse. In ­this ­review we dis­cuss about the effec­tive­ness and the safe­ty of biphas­ic wave­form, by exam­in­ing a ­series of ­human stud­ies ­between 1982 and 1999. We ­have ­found ­that avail­able ­data are ­often incom­plete, ­unclear, dis­ho­mo­ge­ne­ous and, con­se­quent­ly, dif­fi­cult to com­pare. Furthermore, ­among the ­authors ­there is no con­cor­dance ­about the mean­ing of “safe­ty”, “effec­tive­ness”, “suc­cess”, “equiv­alence” and “super­ior­ity” of biphas­ic ver­sus mono­phas­ic ­shock: how­ev­er, biphas­ic ­shock, ­that ­uses a low­er ener­gy lev­el, ­seems to ­reduce ­post-defib­ril­la­tion ­heart dam­age. Due to the ­lack of homo­ge­ne­ous stud­ies it is not pos­sible to ­state ­which ­kind of sig­nal is ­more reli­able, ­even if ­some clin­i­cal ­reports and experi­men­tal ­data ­seem to trib­ute to the biphas­ic wave­form a bet­ter ther­a­peu­tic effec­tive­ness and safe­ty. By exam­in­ing the cur­rent sci­en­tif­ic lit­er­a­ture, we con­clude ­that fur­ther stud­ies ­have to be per­formed to defin­i­tive­ly val­i­date the use of biphas­ic ­shock.

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