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Sudden Cardiac Death, Prehospital Amiodarone Administration and Defibrillation Waveforms Tyler Cascade March 2002 tcasca

Sudden Cardiac Death, Prehospital Amiodarone Administration and Defibrillation Waveforms Tyler Cascade March 2002 tcascade@yahoo.com.

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Sudden Cardiac Death, Prehospital Amiodarone Administration and Defibrillation Waveforms Tyler Cascade March 2002 tcasca

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  1. Sudden Cardiac Death, Prehospital Amiodarone Administration and Defibrillation Waveforms Tyler Cascade March 2002 tcascade@yahoo.com

  2. Question:Is monophasic or biphasic defibrillation better, after a 300 mg IV amiodarone bolus, for the treatment of sudden cardiac death? Hypothesis 1:Monophasic is betterHypothesis 2:Biphasic is betterNull Hypotheses:The relationship between amiodarone, defibrillation threshold, and defibrillation waveforms does not affect survival after sudden cardiac death.

  3. Mortality of Sudden Cardiac Death, USA, 1999. Sudden Cardiac Death (SCD) Definition: • unexpected • cardiac cause • short period of time from symptom onset to cardiac arrest (Centers for Disease Control) 800,000 728,743 700,000 600,000 462,340 500,000 341,780 400,000 323,638 300,000 200,000 120,244 100,000 0 SCD Out-of-Hospital All Cardiac Disease SCD in ED or Dead on Arrival Sudden Cardiac Deaths (SCD) SCD Secondary to myocardial infarction

  4. What can we do to help these folks live longer lives, with a good quality of life?

  5. Early 911 and Dispatcher Assistance Early CPR Early Defibrillation Most Important Early Drugs Epinephrine, Vasopressin Amiodarone, Lidocaine Beta-Adrenergic Blockers

  6. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE,Hallstrom AP, Murray WA, Olsufka M, Walsh T. New England Journal of Medicine. 1999 Sep 16;341(12):871-8. • Survival to Hospital Admission (n=504) • 43% Amiodarone Group • 34% Placebo Group • Survival to Discharge • 13.4% Amiodarone Group • 13.2% Placebo Group • 7% Return to Independent Living or Prior Employment

  7. External & Internal Defibrillation Waveforms Currently In Use MTE1- Monophasic Truncated Exponential MDS2- Monophasic Damped Sine Wave BTE3- Biphasic Truncated Exponential RBW4-Rectilinear Biphasic Waveform 200, 300, 360 Joules 120, 150 Joules

  8. Low Impedance High Impedance 50 50 40 40 30 30 20 20 10 10 0 0 -10 -10 -20 -20 0 4 8 12 0 4 8 12 Biphasic Truncated Exponential Waveform 50 50 40 40 30 30 20 20 10 10 0 0 -10 -10 -20 -20 12 12 8 8 0 0 4 4 Rectilinear Biphasic Waveform Current (amps) Time (msec) Time (msec) 3rd & 4th Generation Waveforms Patient Impedance Variables include: • Distance between electrodes (chest size) • Volume of air in the lungs • Skin properties • The use of conductive gels BTE & RBW Waveforms 50 & 150 Ohms Impedance Compensation 120, 150 Joules

  9. Monophasic Waveforms& Impedance Monophasic Damped Sine Waveform (MDS) Comparison of Waveform with 50 & 150 Ohm Impedances 2nd Generation Figure 8 200, 300, 360 Joules Monophasic Truncated Exponential (MTE) Waveform Comparison of Waveform with 50 & 150 Ohm Impedances 1st Generation Figure 4

  10. Shortening the second phase duration of biphasic shocks: effects of class III antiarrhythmic drugs on defibrillation efficacy in humans.Merkely B; Lubinski A; Kiss O; Horkay F; Lewicka-Nowak E; Kempa M;  Szabolcs Z; Nyikos G; Zima E; Swiatecka G & Geller L.  Journal of  Cardiovascular Electrophysiology. 12(7), 824-7 (Jul 2001).Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary. • Effects of chronic oral amiodarone on defibrillation threshold (Internal defibrillation) • Findings • DFT Affected by amiodarone • amiodarone responded differently to different waveforms • Optimal phase II = 2.5 ms

  11. Patient Impedance amiodarone Monophasic Waveforms Biphasic Waveforms Defibrillation ThresholdMinimum amount of energy needed to successfully defibrillate the heart

  12. Research Web Site:http://academic.evergreen.edu/c/casasp04/

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