High-quality CPR can also help to reduce excess fluid volume in the right ventricle. Two minutes of high-quality CPR can replenish these depleted resources. CPR before defibrillation: In cardiac arrest patients with VF or pulseless VT, the myocardium is deficient in oxygen and necessary nutrients.18-19 It remains to be seen whether the manual mode should be prioritized over the automatic mode (Class IIb). manual modes – Multimodal defibrillators operating in manual mode reduce interruptions in CPR however, there is the risk of an increase in the frequency of shocks delivered inappropriately. Multimodal Defibrillators: Automatic vs.A recurring VF after cardioversion should be shocked with the same dose that successfully terminated that VF initially. For monophasic defibrillators, a dose of 360J should be used for all shocks. Subsequent energy levels delivered should be equivalent or higher. If the provider is unaware of the manufacturer’s suggested effective dose range, a maximum dose should be delivered (Class IIB). Waveform and Energies – For biphasic defibrillators, the manufacturer’s recommendations regarding effective energy doses should be followed for terminating VF (Class I).The cycle is repeated beginning with a rhythm check. The shock is delivered once the patient is cleared and CPR is resumed for two minutes. Once charged, CPR is paused to “clear” the patient. When a manual defibrillator is used, the first provider continues CPR for two minutes while a second provider applies defibrillator pads and charges the defibrillator. This sequence repeats until the victim begins to move or regains consciousness or others arrive to take over the victim’s care. The AED then analyzes the rhythm, charges, and prompts the healthcare provider to shock if necessary the machine then prompts the resumption of CPR following the shock if necessary. The healthcare provider immediately pushes the shock button and resumes CPR immediately for another two minutes. VF or pulseless VT – a rhythm check on an AED after 2 minutes of CPR in a victim with VF or pulseless VT will prompt spontaneous charging of the device and prompt the health care provider to “clear” the victim when the AED is ready to deliver the shock.The following describes the management of the cardiac arrest victim according to rhythm. For example, the health care providers should be prepared to immediately defibrillate a cardiac arrest victim in asystole or PEA who converts into VF or pulseless VT during a rhythm check. The arrest rhythm frequently changes during the course of resuscitation, and management should be modified to the appropriate rhythm-based strategy. 11-17 The key to rhythm-based management is that interruptions in cardiopulmonary resuscitation (CPR) should be as short as possible, giving way only to assess the rhythm, shock VF or pulseless VT if indicated, perform a pulse check when an organized rhythm is achieved or to place an airway. 4-10Ĭonversely, it is important to note that other advanced cardiac life support (ACLS) therapies, such as medical interventions and advanced airways, may improve the likelihood of return of spontaneous circulation (ROSC), but have not shown significant improvement in the rate of survival to hospital discharge. This has resulted in a significant improvement in the rate of survival to hospital discharge. 3 Outcomes in defibrillation are also optimized if the interruptions between chest compressions are minimized. 1-2 Therefore, hospitals should develop a plan to reduce the interval between arrest and rapid defibrillation. The chances of survival decrease as the delay of defibrillation in VF and pulseless VT increases. Asystole is an absence of ventricular electrical activity with or without atrial electric activity. PEA is an organized electric rhythm that is characterized by an absence or insufficient mechanical ventricular activity to produce a detectable pulse. Both of these electrical states are incapable of producing sufficient blood flow. VF is a disorganized electrical activity, while a pulseless VT produces an organized electrical activity. There are four possible electrocardiographic rhythms in cardiac arrest: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), pulseless electrical activity (PEA), and asystole.
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