Next step after a defibrillation attempt
Cardiopulmonary resuscitation (CPR) is an organized, sequential response to cardiac arrest, including
Recognition of absent breathing and circulation
Basic life support with chest compressions and rescue breathing
Advanced cardiac life support (ACLS) with definitive airway and rhythm control
Postresuscitative care
(See also Neonatal Resuscitation and Cardiopulmonary Resuscitation in Infants and Children.)
Prompt initiation of chest compressions and early defibrillation (when indicated) are the keys to success.
Speed, efficiency, and proper application of CPR with the fewest possible interruptions determine successful outcome; the rare exception is profound hypothermia caused by cold water immersion without drowning, when successful resuscitation may be accomplished with intermittent CPR even after prolonged arrest (1).
Guidelines for health care professionals from the American Heart Association (AHA) are followed (see figure Adult Comprehensive Emergency Cardiac Care) (2, 3). If a person has collapsed with possible cardiac arrest, a rescuer first establishes unresponsiveness and confirms absence of breathing or the presence of only gasping respirations. Then
Advanced Cardiac Life Support in Adults
Introduction
Actualisation according to ERC Guidelines 2021.
The content is based mainly on The European Resuscitation Council Guidelines for Resuscitation 2021 (https://cprguidelines.eu/) if not another source is quoted in the text.
Cardiopulmonary Resuscitation (CPR) is the emergency substitution of heart and lung action to restore life to someone who appears dead. The goal of CPR is to prevent brain damage or death. The two main components of conventional cardiopulmonary resuscitation (CPR) are chest compression to make the heart pump and mouth-to-mouth ventilation to breath for the victim. Hands-only CPR is a form of resuscitation that involves continuous, rapid chest compressions only, and although effective, it is not as beneficial as conventional CPR in a patient who is not breathing. The following concept of the Chain of Survival summarises the vital steps needed for successful resuscitation. Most of these links are relevant for victims of both ventricular fibrillation (VF) and asphyxial arrest.
Early recognition of the emergency and calling for help: activate the emergency medical services (EMS) or local emergency
- What should be done to minimize interruptions in chest compressions during CPR?
A. Perform pulse checks only after defibrillation.
B. Continue CPR while the defibrillator is charging.
C. Administer IV medications only when breaths are given.
D. Continue to use AED even after the arrival of a manual defibrillator.
B. Continue CPR while the defibrillator is charging.
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- Which condition is an indication to stop or withhold resuscitative efforts?
A. Unwitnessed arrest
B. Safety threat to providers
C. Patient age greater than 85 years
D. No return of spontaneous circulation after 10 minutes of CPR
B. Safety threat to providers
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- After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The
patient’s lead II ECG appears below. What is your next action?
A. IV or IO access
B. Endotracheal tube placement
C. Consultation with cardiology for possible PCI
D. Application of a transcutaneous pacemaker
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4. After verifying unresponsiveness and abnormal breathing, you activate the emergency rDefibrillation
Continuing Education Activity
Defibrillation is a critical intervention for treating life-threatening cardiac arrhythmias, specifically ventricular fibrillation and pulseless ventricular tachycardia. These conditions cause the heart to lose its effective pumping ability, leading to cardiac arrest and rapid deterioration. Defibrillation depolarizes the heart muscle by delivering a controlled electrical shock, allowing the sinoatrial node to reestablish a coordinated rhythm. Early defibrillation is essential, as survival rates decline by approximately 10% for each minute without intervention, with minimal chance of recovery after 10 minutes. The widespread availability of automated external defibrillators (AEDs) has improved access to timely defibrillation in hospital and community settings. However, optimal patient outcomes depend on rapid rhythm identification, proper device use, and adherence to evidence-based resuscitation protocols.
This course equips clinicians with the knowledge and skills necessary for effective defibrillation in high-risk scenarios. Participants develop competency in rhythm recognition, defibrillator operation, and Advanced Cardiac Li
Mechanism
Defibrillation is defined as the delivery of an electrical shock in order to terminate an arrhythmia, primarily ventricular fibrillation.
Cardioversion relates to the synchronized delivery of an electrical impulse in arrange to depolarize myocardium in a reentrant circuit, so that it may return to sinus rhythm. Cardioversion is primarily used for atrial fibrillation/flutter, AV reentrant tachycardia and ventricular tachycardia.
The defibrillator, when activated, charges a capacitor to the selected energy level in joules and then delivers it to the patient. The power delivered can be in the form of a monophasic or biphasic waveform. Biphasic defibrillators are now considered the standard of care. Biphasic defibrillation delivers an electrical current in one advice from one pad to the second pad and then reverses direction and delivers current from the second pad through the heart to the first pad. Biphasic defibrillators deliver less current, thereby decreasing chances of burns to the skin and injury to myocardium. They are also lighter and more portable than monophasic defibrillators.
On a cellular level, the electrical impulse from defibrillation alters the
- What should be done to minimize interruptions in chest compressions during CPR?