峰值电流在心室颤动患者转复中的作用。

Role of peak current in conversion of patients with ventricular fibrillation.

作者信息

Anantharaman Venkataraman, Wan Paul Weng, Tay Seow Yian, Manning Peter George, Lim Swee Han, Chua Siang Jin Terrance, Mohan Tiru, Rabind Antony Charles, Vidya Sudarshan, Hao Ying

机构信息

Department of Emergency Medicine, Singapore General Hospital, Singapore.

Emergency Department, Tan Tock Seng Hospital, Singapore.

出版信息

Singapore Med J. 2017 Jul;58(7):432-437. doi: 10.11622/smedj.2017070.

DOI:10.11622/smedj.2017070

PMID:28741007

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5523096/

Abstract

INTRODUCTION

Peak currents are the final arbiter of defibrillation in patients with ventricular fibrillation (VF). However, biphasic defibrillators continue to use energy in joules for electrical conversion in hopes that their impedance compensation properties will address transthoracic impedance (TTI), which must be overcome when a fixed amount of energy is delivered. However, optimal peak currents for conversion of VF remain unclear. We aimed to determine the role of peak current and optimal peak levels for conversion in collapsed VF patients.

METHODS

Adult, non-pregnant patients presenting with non-traumatic VF were included in the study. All defibrillations that occurred were included. Impedance values during defibrillation were used to calculate peak current values. The endpoint was return of spontaneous circulation (ROSC).

RESULTS

Of the 197 patients analysed, 105 had ROSC. Characteristics of patients with and without ROSC were comparable. Short duration of collapse < 10 minutes correlated positively with ROSC. Generally, patients with average or high TTI converted at lower peak currents. 25% of patients with high TTI converted at 13.3 ± 2.3 A, 22.7% with average TTI at 18.2 ± 2.5 A and 18.6% with low TTI at 27.0 ± 4.7 A (p = 0.729). Highest peak current conversions were at < 15 A and 15-20 A. Of the 44 patients who achieved first-shock ROSC, 33 (75.0%) received < 20 A peak current vs. > 20 A for the remaining 11 (25%) patients (p = 0.002).

CONCLUSION

For best effect, priming biphasic defibrillators to deliver specific peak currents should be considered.

摘要

引言

峰值电流是心室颤动（VF）患者除颤的最终裁决因素。然而，双相除颤器仍使用焦耳能量进行电转换，希望其阻抗补偿特性能够解决经胸阻抗（TTI）问题，在输送固定量能量时必须克服该阻抗。然而，VF转复的最佳峰值电流仍不清楚。我们旨在确定峰值电流在虚脱的VF患者转复中的作用以及最佳峰值水平。

方法

纳入出现非创伤性VF的成年非妊娠患者。纳入所有发生的除颤情况。使用除颤期间的阻抗值计算峰值电流值。终点是自主循环恢复（ROSC）。

结果

在分析的197例患者中，105例实现了ROSC。有ROSC和无ROSC患者的特征具有可比性。虚脱持续时间短<10分钟与ROSC呈正相关。一般而言，TTI平均或较高的患者在较低的峰值电流下转复。TTI高的患者中有25%在13.3±2.3A时转复，TTI平均的患者中有22.7%在18.2±2.5A时转复，TTI低的患者中有18.6%在27.0±4.7A时转复（p = 0.729）。最高峰值电流转复发生在<15A和15 - 20A时。在44例首次除颤实现ROSC的患者中，33例（75.0%）接受的峰值电流<20A，其余11例（25%）患者接受的峰值电流>20A（p = 0.002）。