Jian Huang1, Richard B Ruse2, Gregory P Walcott1, Silvio Litovsky3, Scott J Bohanan2, Da-Wei Gong4, Mark W Kroll5. 1. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama. 2. Ruse Technologies, LLC, Atlanta, Georgia. 3. Department of Medicine, Department of Pathology, University of Alabama at Birmingham, Alabama. 4. School of Medicine, University of Maryland, Baltimore, Maryland. 5. Department of Biomedical Engineering, University of Minnesota Crystal Bay, Minnesota; Department of Biomedical Engineering, California Polytechnical University, San Luis Obispo, California. Electronic address: mark@kroll.name.
Abstract
OBJECTIVES: This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model. BACKGROUND: Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival. METHODS: An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion with amplitudes of 20 J (ASC 20J) and 25 J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE 25J) RESULTS: The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6 of 14 pigs (p < 0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24 h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6 h post-shock. CONCLUSIONS: Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTE waveform.
OBJECTIVES: This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model. BACKGROUND: Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival. METHODS: An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion with amplitudes of 20 J (ASC 20J) and 25 J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE 25J) RESULTS: The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6 of 14 pigs (p < 0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24 h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6 h post-shock. CONCLUSIONS:Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTE waveform.
Authors: Ben McCartney; Adam Harvey; Amy Kernaghan; Sara Morais; Olibhéar McAlister; Paul Crawford; Pardis Biglarbeigi; Raymond Bond; Dewar Finlay; David McEneaney Journal: Resusc Plus Date: 2022-02-01
Authors: Tobias Neumann; Simon-Richard Finke; Maja Henninger; Sebastian Lemke; Ben Hoepfner; Daniel Steven; Alexandra C Maul; Daniel C Schroeder; Thorsten Annecke Journal: Resusc Plus Date: 2020-06-01