Comparison of five different defibrillators using recommended energy protocols.

Biphasic defibrillators represent a great step ahead in defibrillation. The manufacturers claim that biphasic defibrillators are able to compensate for differences in transthoracic impedance. That should mean that all patients should be defibrillated with approximately the same amount of current, regardless of their transthoracic impedance. We assessed one monophasic and four biphasic defibrillators. The defibrillators were discharged into resistive loads of 50, 90 and 130 Omega, simulating transthoracic impedance. For each waveform we used energy protocols recommended by the manufacturers and guidelines 2005. Waveforms were observed with on a digitising oscilloscope on a current sensing resistor. We compared the electrical properties of different waveforms and two defibrillators with the same type of waveform. The influence of different impedance on shape, duration and amplitude of current flow were also observed for each waveform. Measurements showed a significant difference in current flow at different impedance loads. At low impedance the mean current is well above expectations for all the defibrillators studied and at high impedance load we observed a big reduction of current amplitude. We can conclude that the compensating mechanisms of biphasic defibrillators are, from electrical point of view, negligible. From the laws of physics it is practically impossible to keep same level of current at given time with same energy at higher impedance. That is why we should reconsider the use of different energy equivalents between patients with different transthoracic impedance and not between different defibrillation impulses.