Zur Technik der biphasischen und monophasischen Defibrillation

Zusammenfassung

Die frühzeitige transthorakale Defibrillation ist ein wichtiges Glied in der Kette der lebenserhaltenden Erstmaßnahmen zur Beendigung eines bestehenden Kammerflimmerns/-flatterns. Der Einsatz biphasischer Impulsformen (Stromkurven) ermöglicht gegenüber monophasischen Impulsformen bei geringerer Energiemenge eine Rhythmuskonversion mit gleichhoher (bzw. höherer) Effizienz. Hierdurch können mögliche strominduzierte Myokardschäden deutlich reduziert werden. Auch bei individuell veränderter Thoraximpedanz kann durch eine geräteseitige Impedanzkompensation und biphasische Impulsform eine effiziente Rhythmuskonversion erfolgen. Die zur biphasischen Konversion benötigte geringere Energie, Stromstärke und Spannung erlauben eine weitere Miniaturisierung der Defibrillatoren. Dies ermöglicht in Verbindung mit einer hochsensitiven, automatischen Rhythmusanalyse eine weitere Verbreitung halb-/automatischer Defibrillatoren in der Öffentlichkeit. Hierdurch kann ein wichtiges Glied in der Kette der lebenserhaltenden Erstmaßnahmen gestärkt werden.

Early external defibrillation to terminate ventricular fibrillation remains an important procedure in cardiopulmonary resuscitation. As compared to monophasic impuls generation, biphasic impulse generation allows the use of lower current levels while being equally or even more efficient in terms of successful defibrillation. As a result the extent of current induced myocardial damage seems to be decreased. Individual differences in thoracic impedance can be better compensated by the biphasic external defibrillator, resulting in more efficient defibrillation. Biphasic impulse defibrillation requires less voltage, current and, therefore less energy than monophasic defibrillation. As a consequence the defibrillator can be reduced in size and weight. This, in combination with a highly sensitive automatic rhythm analysis will lead to a wider public use of these automatic (or semiautomatic) external defibrillators. As a consequence early defibrillation will become more common.

Schlüsselwörter

Defibrillation - biphasisch - monophasisch - Impulsform - Thoraximpedanz

Key words

Defibrillation - Biphasic - Monophasic - Waveform - Impedance

Literatur

• 1 Cummins R O, Ornato J P, Thies W H, Pepe P E. Improving survival from sudden cardiac arrest: The „chain of survival” concept - a statement for health professionals from the Advanced Cardiac Care Commitee. American Heart Association.  Circulation. 1991;  83 1832-1847
• 2 White R D. External defibrillation: The need for uniformity in analyzing and reporting results.  Ann. Emerg. Med.. 1998;  32 234-236
• 3 Beck C S, Pritchard W H, Feil H S. Ventricular fibrillation of long duration abolished by electric shock.  JAMA. 1947;  135 985-986
• 4 Zoll D P, Linenthal A J, Gibson W, Paul M H, Norman L R. Termination of ventricular fibrillation in man by externally applied electric countershock.  N. Eng. J. Med.. 1956;  254 726-732
• 5 Kouwenhoven W B, Milnor W R, Knickerbocker G G, Chesnut W R. Closed chest defibrillation of the heart.  Surgery. 1957;  42 550-561
• 6 Lown B, Neumann J, Amarasingham R, Barkovits B V. Comparison of alternating current with direct current electroshock across the closed chest.  Am. J. Cardiol.. 1962;  10 223-233
• 7 Anderson G J, Suelzer J S. The efficacy of trapezoidal wave forms for ventricular defibrillation.  Chest. 1976;  70 298-300
• 8 Campbell N P, Webb S W, Adgey A A, Pantridge J F. Transthoracic ventricular defibrillation in adults.  Br. Med. J.. 1977;  26 1379-1381
• 9  American Heart Association. Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC).  JAMA. 1986;  255 2905-2989
• 10 Kerber R E, Becker L B, Bourland J D, Cummins R O, Hallstrom A P, Michos M B, Nichol G, Ornato J P, Thies W H, White R D, Zuckerman B D. Automatic external defibrillators for public access defibrillation: Recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety.  Biomed. Instrument Technol.. 1997;  31 238-244
• 11 Kerber R E, Becker L B, Bourland J D, Cummins R O, Hallstrom A P, Michos M B, Nichol G, Ornato J P, Thies W H, White R D, Zuckerman B D. Automatic external defibrillators for public access defibrillation: Recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety.  Circulation. 1997;  95 1677-1682
• 12 Atkins D L, Hartley L L, York D K. Accurate recognition and effective treatment of ventricular fibrillation by automated external defibrillators in adolescents.  Pediatrics. 1998;  101 393-397
• 13 Sweeney R J, Gill R M, Reid P R. Refractory interval after transcardiac shocks during ventricular fibrillation.  Circulation. 1996;  94 2947-2952
• 14 Tovar O H, Jones J L. Biphasic defibrillation waveforms reduce shock-induced response duration dispersion between low and high shock intensities.  Circ. Res.. 1995;  77 430-438
• 15 Bardy G H, Marchlinski F E, Sharma A D, Worley S J, Luceri R M, Yee R, Halperin B D, Fellows C L, Ahern T S, Chilson D A, Packer D L, Wilber D J, Mattioni T A, Reddy R, Kronmal R A, Lazzara R. Multicenter comparison of trunced biphasic shock and standard damped sine wave monophasic shocks for transthoracic ventricular defibrillation.  Circulation. 1996;  94 2507-2514
• 16 Bardy G H, Gliner B E, White R D. Comparison of human defibrillation efficacy rates in short-duration and long-duration ventricular fibrillation using monophasic and biophasic transthoracic shocks.  Circulation. 1997;  96, Suppl. I 1-560
• 17 Gliner B E, Lyster T E, Dillion S M, Bardy G H. Transthoracic defibrillation of swine with monophasic and biphasic waveforms.  Circulation. 1995;  92 1634-1643
• 18 Greene H L, DiMarco J P, Kudenchuk P J, Scheinman M M, Tang A SL, Reiter M J, Echt D S, Chapman P D, Jazayeri M R, Chapman F W, Ahmed M, Johnson J L, Niskanen R A. Comparison of monophasic and biphasic defibrillation pulse waveforms for transthoracic cardioversion.  Am. J. Cardiol.. 1995;  75 1135-1139
• 19 Herre J M, Higgins S L, Epstein A E. A comparison of biphasic and monophasic shocks for external defibrillation of humans.  Circulation. 1998;  98, Suppl. I 1-173
• 20 Poole J E, White R D, Kanz K G, Hengstenberg F, Jarrad G T, Robinson J C, Santana V, McKensas D K, Rich N, Rosas S, Merritt S, Magnotto L, Gallagher J V, Gliner B E, Jorgenson D B, Morgan C B, Dillon S M, Kronmal R A, Bardy G H. Low-energy impedance-compensating biphasic waveforms terminate ventricular fibrillation at high rates in victims of out-of-hospital cardiac arrest.  J. Cardiovasc. Electrophysiol.. 1997;  8 1373-1385
• 21 Bardy G H, Gilner B E, Kudenchuk P J, Poole J E, Dolack G L, Jones G K, Anderson J, Troutman C, Johnson G. Truncated biphasic pulse for transthoracic defibrillation.  Circulation. 1995;  91 1768-1774
• 22 Behrens S, Li C, Kirchhof P, Fabritz F L, Franz M R. Reduced arrhythmogenecity of biphasic versus monophasic T-wave shocks.  Circulation. 1996;  94 1974-1980
• 23 Jones J L, Jones R E. Improved defibrillator waveform safety factor with biphasic waveforms.  Am. J. Physiol.. 1983;  245 60-65
• 24 Jones J L, Jones R E. Decreased defibrillator-induced dysfunction with biphasic rectangular waveforms.  Am. J. Physiol.. 1984;  247 792-796
• 25 Wilson C M, Bailey A, Allen J D, Anderson J, Adgey A A. Cardiac injury with damped sine and trapezoidal defibrillator waveforms.  Eur. J. Cardiol.. 1989;  10 628-636
• 26 Reddy R K, Gleva M J, Gliner B E, Dolack G L, Kudenchuk P J, Poole J E, Bardy G H. Biphasic transthoracic defibrillation causes fewer ECG ST-segment changes after shock.  Ann. Emerg. Med.. 1997;  30 127-134
• 27 Ujhelyi M R, Schur M, Frede T, Gabel M, Markel M L. Differential effects of lidocaine on defibrillation threshold with monophasic versus biphasic shock waveforms.  Circulation. 1995;  92 1644-1650
• 28 Kudenchuk P J, Poole J E, Dolack G L, Troutman A J, Bardy G H. Prospective evaluation of the effect of biphasic waveform defibrillation on ventricular pacing thresholds.  J. Cardiovasc. Electrophysiol.. 1997;  8 485-495
• 29 Poole J E, Kudenchuk P J, Dolack G L, Jones G K, Degroot P, Johnson G, Bardy G H. A prospective randomized comparison in humans of 90-µF and 120-µF biphasic pulse defibrillation using a unipolar defibrillation system.  J. Cardiovasc. Electrophysiol.. 1995;  6 1097-1100
• 30 Schröder T. Persönliche Mitteilung. Medtronic-Physio-Control 1999
• 31 Jones E J. Persönliche Mitteilung. ZOLL-Medical-Corporation 1999

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