Long Brit, Gottlieb Michael
Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Am J Emerg Med. 2025 May 18;95:57-62. doi: 10.1016/j.ajem.2025.05.022.
Cardiac arrest is a commonly managed condition in the emergency department (ED), and defibrillation of shockable rhythms is a key component of treatment, along with high-quality chest compressions.
This narrative review seeks to evaluate evidence-based updates concerning defibrillation in cardiac arrest.
Cardiac arrest management includes cardiopulmonary resuscitation (CPR) and defibrillation of shockable rhythms. CPR should be provided until a defibrillator is applied. In those with pulseless ventricular tachycardia or ventricular fibrillation, defibrillation should be performed as soon as possible. If the arrest is unwitnessed, or there will be a delay in rhythm analysis or applying/obtaining a defibrillator, CPR should be performed while the defibrillator is being obtained and prepared for use. Biphasic waveform defibrillators are recommended. Shorter pre- and peri-shock pauses are associated with higher survival rates. Charging the defibrillator during chest compressions, holding compressions for rhythm analysis alone, and immediately resuming compressions following defibrillation are recommended to maximize chest compression fraction. Two common defibrillator pad configurations include anterolateral (AL) and anterior-posterior (AP). Vector-change defibrillation can be attempted if the first defibrillation attempt is unsuccessful. Double defibrillation (DD) includes either double simultaneous defibrillation (DSD) or dual sequential external defibrillation (DSED), though DSED is more common. DD utilizes two biphasic defibrillators and two sets of defibrillator pads in an AL and AP configuration. If the patient is refractory to 3 or more defibrillation attempts, DD may be attempted. Defibrillator damage with DD is rare, and clinicians must consider the potential survival benefit with DD, patient and provider safety issues, cost, and system-level impact when using two defibrillators.
An understanding of literature updates focused on defibrillation can improve the ED care of patients in cardiac arrest.
心脏骤停是急诊科常见的处理病症，除高质量胸外按压外，对可除颤心律进行除颤是治疗的关键组成部分。
本叙述性综述旨在评估心脏骤停除颤的循证更新情况。
心脏骤停的处理包括心肺复苏（CPR）和对可除颤心律进行除颤。应持续进行心肺复苏直至应用除颤器。对于无脉性室性心动过速或心室颤动患者，应尽快进行除颤。如果心脏骤停未被目击，或者在心律分析、应用/获取除颤器方面会有延迟，应在获取并准备使用除颤器时进行心肺复苏。推荐使用双相波除颤器。较短的电击前和电击周围暂停时间与较高的生存率相关。建议在胸外按压期间对除颤器充电，仅为心律分析暂停按压，并在除颤后立即恢复按压，以最大化胸外按压比例。两种常见的除颤器电极片配置包括前外侧（AL）和前后位（AP）。如果首次除颤尝试未成功，可尝试向量改变除颤。双重除颤（DD）包括同时双相除颤（DSD）或双序列体外除颤（DSED），不过DSED更常见。DD使用两台双相除颤器和两组呈AL和AP配置的除颤器电极片。如果患者对≥3次除颤尝试无效，可尝试双重除颤。双重除颤导致除颤器损坏的情况罕见，临床医生在使用两台除颤器时必须考虑双重除颤的潜在生存获益、患者和医护人员安全问题、成本以及系统层面的影响。
了解聚焦于除颤的文献更新可改善急诊科对心脏骤停患者的护理。
