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Resuscitation. 2001 Nov;51(2):159-63.

Pediatric transthoracic defibrillation: biphasic versus monophasic waveforms in an experimental model.

Author information

1
The Cardiovascular Center, The University of Iowa, Iowa City, IA 52242, USA.

Abstract

OBJECTIVES:

The purpose of this study was to determine and compare the efficacy of biphasic and monophasic waveforms in a porcine model of pediatric defibrillation.

BACKGROUND:

The efficacy and safety of biphasic waveforms in children has not been established.

METHODS:

We initially studied 27 piglets: 12 weighed 3-6 kg ('infants'), and 15 weighed 7-12 kg ('children'). Ventricular fibrillation (VF) was induced by rapid right ventricular pacing and maintained for 15 s. Transthoracic shocks of 7-100 J energy were given using monophasic (5 ms truncated exponential) and biphasic (5 ms positive, 5 ms negative pulse, truncated exponential) waveforms. A second study of four 'infant' and four 'child' piglets utilized the same protocol but with a 10 ms instead of 5 ms monophasic truncated exponential shock waveform compared with the 10 ms biphasic waveform.

RESULTS:

For both biphasic and monophasic waveforms, shock success rate (termination of VF) rose steadily as energy was increased. In the first study in the 'infant' 3-6 kg group, the 10 ms biphasic waveforms were superior to 5 ms monophasic waveforms at 10, 20, and 30 J energies, and in the 'child' 7-12 kg group at 20 and 30 J energies (P<0.05). High success rates (>80%) were achieved by 20 J (4 J/kg) biphasic waveform shocks in the 'infant' piglets and 30 J (3 J/kg) biphasic waveform shocks in the 'child' piglets. In the second study using a 10 ms monophasic waveform, we found similar results. Pulseless electrical activity occurred in two animals following biphasic shocks and in two animals following monophasic shocks.

CONCLUSIONS:

Biphasic waveforms proved superior to monophasic waveforms in both infant and child models. High success rates were achieved with low-energy biphasic shocks. Biphasic waveform defibrillation is a promising advance in pediatric resuscitation.

PMID:
11718971
DOI:
10.1016/s0300-9572(01)00398-7
[Indexed for MEDLINE]

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