McCartney Ben, Harvey Adam, Kernaghan Amy, Morais Sara, McAlister Olibhéar, Crawford Paul, Biglarbeigi Pardis, Bond Raymond, Finlay Dewar, McEneaney David
Faculty of Computing, Engineering & Built Environment, Ulster University, Newtownabbey, United Kingdom.
HeartSine Technologies Ltd., Stryker Belfast, Belfast, United Kingdom.
Resusc Plus. 2022 Feb 1;9:100203. doi: 10.1016/j.resplu.2022.100203. eCollection 2022 Mar.
Automated external defibrillators (AEDs) use various shock protocols with different characteristics when deployed in pediatric mode. The aim of this study is to assess and compare the safety and efficacy of different AED pediatric protocols using novel experimental approaches.
Two defibrillation protocols (A and B) were assessed across two studies: Protocol A: escalating (50-75-90 J) defibrillation waveform with higher voltage, shorter duration and equal phase durations. Protocol B; non-escalating (50-50-50 J) defibrillation waveform with lower voltage, longer duration and unequal phase durations.Experiment 1: Isolated shock damage was assessed following shocks to 12 anesthetized pigs. Animals were randomized into two groups, receiving three shocks from Protocol A (50-75-90 J) or B (50-50-50 J). Cardiac function, cardiac troponin I (cTnI), creatine phosphokinase (CPK) and histopathology were analyzed. Experiment 2: Defibrillation safety and efficacy were assessed through shock success, ROSC, ST-segment deviation and contractility following 16 randomized shocks from protocol A or B delivered to 10 anesthetized pigs in VF.
Experiment 1: No clinically meaningful difference in cTnI, CPK, ST-segment deviation, ejection fraction or histopathological damage was observed following defibrillation with either protocol. No difference was observed between protocols at any timepoint. Experiment 2: all defibrillation types demonstrated shock success and ROSC ≥ 97.5%. Post-ROSC contractility was similar between protocols.
There is no evidence that administration of clinically relevant shock sequences, without experimental confounders, result in significant myocardial damage in this model of pediatric resuscitation. Typical variations in AED pediatric mode settings do not affect defibrillation safety and efficacy.
自动体外除颤器（AED）在儿科模式下使用具有不同特征的各种电击方案。本研究的目的是使用新的实验方法评估和比较不同AED儿科方案的安全性和有效性。
在两项研究中评估了两种除颤方案（A和B）：方案A：递增（50 - 75 - 90 J）除颤波形，电压更高、持续时间更短且相位持续时间相等。方案B：非递增（50 - 50 - 50 J）除颤波形，电压更低、持续时间更长且相位持续时间不相等。实验1：对12只麻醉猪进行电击后评估孤立性电击损伤。将动物随机分为两组，分别接受方案A（50 - 75 - 90 J）或B（50 - 50 - 50 J）的三次电击。分析心脏功能、心肌肌钙蛋白I（cTnI）、肌酸磷酸激酶（CPK）和组织病理学。实验2：通过对10只处于室颤的麻醉猪进行方案A或B的16次随机电击后的电击成功率、自主循环恢复（ROSC）、ST段偏移和收缩性来评估除颤安全性和有效性。
实验1：两种方案除颤后，在cTnI、CPK、ST段偏移、射血分数或组织病理学损伤方面均未观察到具有临床意义上的差异。在任何时间点，两种方案之间均未观察到差异。实验2：所有除颤类型的电击成功率和ROSC均≥97.5%。方案之间ROSC后的收缩性相似。
没有证据表明在无实验混杂因素的情况下给予临床相关电击序列会在该儿科复苏模型中导致显著的心肌损伤。AED儿科模式设置的典型变化不会影响除颤安全性和有效性。
