用于经胸除颤的环绕重叠多脉冲电击波形

Encircling overlapping multipulse shock waveforms for transthoracic defibrillation.

作者信息

Pagan-Carlo L A, Allan J J, Spencer K T, Birkett C L, Myers R, Kerber R E

机构信息

Department of Internal Medicine, University of Iowa Hospital, Iowa City 52242, USA.

出版信息

J Am Coll Cardiol. 1998 Dec;32(7):2065-71. doi: 10.1016/s0735-1097(98)00486-0.

DOI:10.1016/s0735-1097(98)00486-0

PMID:9857894

Abstract

OBJECTIVES

This study was performed to determine the efficacy of new encircling overlapping multipulse, multipathway waveforms for transthoracic defibrillation.

BACKGROUND

Alternative waveforms for transthoracic defibrillation may improve shock success.

METHODS

First, we determined the shock success achieved by three different waveforms at varying energies (18-150 J) in 21 mongrel dogs after short-duration ventricular fibrillation. The waveforms tested included the traditional damped sinusoidal waveform, a single pathway biphasic waveform, and a new encircling overlapping multipulse waveform delivered from six electrode pads oriented circumferentially. Second, in 11 swine we compared the efficacy of encircling overlapping multipulse shocks given from six electrode pads and three capacitors versus encircling overlapping shocks given from a device utilizing three electrodes and one capacitor.

RESULTS

In the first experiment, the encircling overlapping waveform performed significantly better than biphasic and damped sinusoidal waveforms at lower energies. The shock success rate of the overlapping waveform (six pads) ranged from 67+/-4% (at 18-49 J energy) to 99+/-3% at > or = 150 J; at comparable energies biphasic waveform shock success ranged from 26+/-5% (p < 0.01 vs. encircling overlapping waveforms) to 99+/-5% (p = NS). Damped sinusoidal waveform shock success ranged from 4+/-1% (p < 0.01 vs. encircling overlapping waveform) to 73+/-9% (p = NS). In the second experiment the three electrode pads, one capacitor encircling waveform achieved shock success rates comparable with the six-pad, three-capacitor waveform; at 18-49 J, success rates were 45+/-15% versus 57+/-12%, respectively (p = NS). At 100 J, success rates for both were 100%.

CONCLUSIONS

We conclude that encircling overlapping multipulse multipathway waveforms facilitate transthoracic defibrillation at low energies. These waveforms can be generated from a device that requires only three electrodes and one capacitor.

摘要

目的

本研究旨在确定新型环绕重叠多脉冲、多路径波形用于经胸除颤的疗效。

背景

经胸除颤的替代波形可能会提高电击成功率。

方法

首先，我们测定了21只杂种犬在短阵室颤后，三种不同波形在不同能量（18 - 150焦耳）下的电击成功率。测试的波形包括传统的阻尼正弦波形、单路径双相波形以及由六个沿圆周方向排列的电极垫发出的新型环绕重叠多脉冲波形。其次，在11头猪中，我们比较了由六个电极垫和三个电容器发出的环绕重叠多脉冲电击与由一个使用三个电极和一个电容器的装置发出的环绕重叠电击的疗效。

结果

在第一个实验中，环绕重叠波形在较低能量下的表现明显优于双相波形和阻尼正弦波形。重叠波形（六个电极垫）的电击成功率在18 - 49焦耳能量时为67±4%，在≥150焦耳时为99±3%；在相当能量下，双相波形的电击成功率在26±5%（与环绕重叠波形相比，p < 0.01）至99±5%（p = 无显著差异）之间。阻尼正弦波形的电击成功率在4±1%（与环绕重叠波形相比，p < 0.01）至73±9%（p = 无显著差异）之间。在第二个实验中，三个电极垫、一个电容器的环绕波形的电击成功率与六个电极垫、三个电容器的波形相当；在18 - 49焦耳时，成功率分别为45±15%和57±12%（p = 无显著差异）。在100焦耳时，两者的成功率均为100%。