Kerber R E
Ann Emerg Med. 1984 Sep;13(9 Pt 2):794-7. doi: 10.1016/s0196-0644(84)80440-0.
Recent technological advances have enhanced our ability to diagnose and treat ventricular fibrillation (VF). Self-adhesive electrode pads for external defibrillation are as effective as standard hand-held paddle electrodes, and have substantial advantages for monitoring during transportation and in the emergency department/intensive care unit/critical care unit. These electrode pads work equally well whether placed in apex-anterior or apex-posterior positions. Preapplication in calm, prearrest circumstances assures accurate placement and enhances shock success. Transthoracic impedance is a critical determinant of the success of low-energy shocks. Prediction of transthoracic impedance in advance of the first shock is now feasible. First-shock energy can then be based on impedance, and inappropriate low energies for high-impedance patients may be avoided. Automatic external defibrillation by minimally trained rescuers extends our ability to treat out-of-hospital ventricular fibrillation. A vertical defibrillation pathway, using the tongue as one electrode site, allows rapid, automated detection of VF. Animal defibrillation studies and preliminary human studies (during elective cardioversion) have demonstrated the efficacy of the pathway and defined the impedance and energy requirements. Clinical trials of the device for out-of-hospital defibrillation are now in progress.
最近的技术进步提高了我们诊断和治疗心室颤动（VF）的能力。用于体外除颤的自粘性电极片与标准手持电极板效果相同，并且在运输过程中以及在急诊科/重症监护病房/重症护理病房进行监测时具有显著优势。无论放置在心尖 - 前位还是心尖 - 后位，这些电极片的效果都一样好。在平静、心跳骤停前的情况下预先应用可确保准确放置并提高除颤成功率。经胸阻抗是低能量除颤成功的关键决定因素。现在在首次除颤之前预测经胸阻抗是可行的。然后首次除颤能量可以基于阻抗，从而避免对高阻抗患者使用不适当的低能量。由经过最少培训的救援人员进行自动体外除颤扩展了我们治疗院外心室颤动的能力。使用舌头作为一个电极部位的垂直除颤途径能够快速、自动检测心室颤动。动物除颤研究和初步人体研究（在择期心脏复律期间）已经证明了该途径的有效性，并确定了阻抗和能量要求。用于院外除颤的该设备的临床试验目前正在进行中。
