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A comparison of biphasic manual and semi-automatic external defibrillation

02 June 2023
Features
02 June 2023
Volume 15 · Issue 6

Abstract

Background:

Biphasic manual defibrillation (MD) is advocated as the preferred strategy for paramedics ahead of semi-automatic external defibrillation (SAED) for out-of-hospital cardiac arrest (OHCA).

Methods:

A systematic review involved searching CINAHL, MEDLINE and Embase academic databases. Comparative studies where both strategies were tested for time to first defibrillation (TTFD) and related Utstein-based model outcomes were examined to discern which strategy was superior.

Results:

Two studies met the criteria. One study found that in 4552 SAED episodes of defibrillation (30.8% of the 14 776 total defibrillation episodes), a decrease of >10% in mean TTFD (P<0.001) of an intial shockable rhythm was recorded. The same study reported an overall decrease in TTFD within 2 minutes (95% CI/P<0.001), with a 68% improved odds of receiving a shock within two minutes. SAED was associated with a 26% reduction in the risk-adjusted odds of survival (95% CI/P<0.009), attributed to cardiopulmonary resuscitation (CPR) delays. The other examined 160 defibrillations in OHCA. The MD median TTFD was 7 seconds faster (95% CI/P<0.0001) and responsible for 20% more inappropriate shocks.

Conclusions:

Modern SAED is superior in reducing TTFD and inappropriate shocks. The modern SAED and MD strategies can be enhanced by interruption-reducing technology. New SAED algorithms can detect shockable rhythms in 3 seconds. More randomised studies need to be conducted using up-to-date devices. A multifaceted approach incorporating technological advancements, ongoing research and training is necessary to ensure that the most effective defibrillation strategy is employed.

English ambulance services resuscitate 28 000 people in out-of-hospital cardiac arrest (OHCA) each year using evidenced-based algorithms in the Resuscitation Council UK's (RCUK) advanced life support (ALS) guidelines (Soar et al, 2021). The majority are adults who arrest from issues of cardiogenic origin (El-Sherif et al, 2010). Around 8% survive to discharge following early recognition of a defibrillatable or shockable ventricular rhythm and early defibrillation within the chain of survival (Soar et al, 2021). In OHCA, 23% of arrests in people aged <65 years have an initial shockable rhythm across all responder types (Nadolny et al, 2018).

Aetiology, bystander cardiopulmonary resuscitation (CPR), time to first defibrillation (TTFD) and presenting rhythm are all variables within an Utstein-based model that gives prognostic relevance of the factors that improve survival outcomes (Baldi et al, 2020). When using this Utstein-based model, 17.4% of patients have a shockable rhythm and one-third of paramedic defibrillations result in event survival (Baldi et al, 2020).

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Out-of-hospital cardiac arrest
Manual defibrillation
Semi-automatic external defibrillation
Pre-shock pause
CPR interruptions
Rhythm analysis