Intramyocardial current flow is a critical factor in successful ventricular defibrillation. The main determinants of intramyocardial current flow during transthoracic countershock are the selected energy and the transthoracic impedance of the patient. To optimise the success of the first shock and to titrate energy dosage according to each patient's transthoracic impedance, a microprocessor controlled current based defibrillator was developed. It was compared with a conventional energy based protocol of 200 J (delivered energy), 200 J, then 360 J if required in 42 consecutive episodes of ventricular fibrillation in 33 men and seven women. The mean (SD) predicted transthoracic impedance was 69.9 (14.0) omega. First shock success with the standard protocol was 80.9%, and first or second shock success was 95.2%. The microprocessor controlled current based defibrillator automatically measured transthoracic impedance and calculated the energy required to develop a selected current in each patient. A current protocol of 30 A, 30 A, then 40 A, if required, was used in 29 men and 12 women with 41 episodes of ventricular fibrillation. Transthoracic impedance (mean 65.1 (15.9) omega) was similar to that in the energy protocol group and success rates for first shock (82.9%) and first or second shocks (97.5%) were also similar. The mean delivered energy per shock with the current based defibrillator for first or second shock success was significantly less (144.8 J) with the energy protocol (200 J). The mean peak current of successful shocks was also significantly reduced (29.0 v 31.9 A). A current based defibrillator titrates energy according to transthoracic impedance; it has a success rate comparable to conventional defibrillators but it delivers significantly less energy and current per shock.
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