á la carte defibrillation poised to enter the fixed price resuscitation menu

摘要

The success of defibrillation during CPR has improved significantly over the past two decades, mostly as a result of the replacement of relatively ineffective monophasic waveforms with more efficacious, lower energy biphasic waveforms, but also as the need to minimize pre-shock pauses has been recognized.We are still however continuing to defibrillate patients blindly during CPR using a fixed time-based protocol, stopping every 2 min and delivering a shock if indicated. For some patients, the defibrillation attempt will succeed, but may have been able to be successfully delivered earlier, avoiding unnecessary chest compressions and progressive myocardial and cerebral deterioration. For others, the defibrillation attempt will fail; an intervention that is not cost neutral, as it results in some degree of myocardial stunning and interruptions to CPR that may worsen outcome.