Effects of Transthoracic Impedance and Peak Current Flow on Defibrillation Success in a Prehospital Setting, , ,

Study objective: To assess whether transthoracic impedance and peak current are determinants of defibrillation success in patients with out-of-hospital ventricular fibrillation (VF). Methods: A retrospective cohort study was carried out in a suburban Canadian EMS system. Participants were patients who experienced out-of-hospital cardiac arrest in the regional municipality of Ottawa-Carleton, had VF rhythm at presentation, and received countershocks from the Laerdal Heartstart 2000 automated external defibrillator. Results: A total of 310 patients met the inclusion criteria. Collectively they received 717 countershocks. The first shocks were successful in converting VF rhythm 25.5% of the time. The most important determinant of shock success was the interval from when the call was received until delivery of the first shock (P<.01). Length of time at scene, current, impedance, and patient age were not significant determinants of success of first shock. The time interval until first shock was also a determinant of survival (P<.01). EMS response time, whether the arrest was witnessed, initial impedance, and current were not determinants of survival. Conclusion: OHCA shock success and survival are associated with EMS system factors such as the interval from when the call was received until delivery of the first shock. The importance of impedance and peak current remain theoretic for out-of-hospital defibrillation success and did not influence defibrillation success in this study. [Heavens JP, Cleland MJ, Maloney JP, Rowe BH: Effects of transthoracic impedance and peak current flow on defibrillation success in a prehospital setting. Ann Emerg Med August 1998;32: 191-199.]