R E SUS CI TATION
The focus must always be on preventing cardiac arrest from occurring. Greater emphasis on recognising and treating the deteriorating patient should be every NHS Trust’s responsibility, in line with other Guidelines such as NICE (CG50). With the growing recognition that many cardiac arrests can be identified in advance, it makes sense to employ comprehensive monitoring, where
possible, to reduce mortality. Anthony Freestone, RCUK regional representative for the North West
nasal breathers. The system is designed to overcome traditional capnograph challenges, minimising the chances of clogs or cross sensitivity with other gasses, to ultimately improve clinical decision making and response times.
Speed Preventing any time spent in cardiac arrest is, of course, a crucial aspect of resuscitation, with studies suggesting that when a patient suffers cardiac arrest, success rates for defibrillation drop for every second between CPR and defibrillation shock.5
rescuers, their equipment should minimise any delay incurred by charging times or operation of the equipment itself. Both the D3 and D6 defibrillators can deliver a shock in just five seconds including initial start-up, providing defibrillation in rapid time.
Energy levels
This means that comprehensive data on its own is not enough; speed is vital. The RCUK’s strategy for manual defibrillation is: “Give a shock as early as possible when appropriate.” For this guideline to be adhered to by
The guidelines also give medical professionals more freedom to operate within an energy range when responding to cardiac event. Between 120J-360J is acceptable for the initial shock, followed by a fixed or escalating strategy up to maximum output of the defibrillator.6 Mr Freestone said: “For fixed high energy
versus escalating shocks protocols, this is a very exciting time. The guidelines again highlight escalation of energy after a failed shock, and for patients where refibrillation
has occurred, but now give us the option of starting within an energy range, empowering Resuscitation Departments to think outside the box when it comes to defibrillation energy requirements.” However, this range means that defibrillators that are limited to, or recommend, lower shock levels may struggle with escalating strategies. Mindray’s C series and D series range of defibrillators can achieve escalating biphasic shocks up to 360J, to help maximise the chances of successful resuscitation in line with ERC and RCUK recommendations. Support for the escalating strategy comes from studies in the ERC guidelines, which suggested a benefit from higher subsequent energy levels for refibrillation.7
The ERC
said: “We recommend that if a shockable rhythm recurs after successful defibrillation with ROSC, and the defibrillator is capable of delivering shocks of higher energy, it is reasonable to increase the energy for subsequent shocks.”8
While the RCUK states an energy range of 120J-360J is acceptable, the justification for this in the ERC guidelines indicate the higher energy ranges may be able to achieve greater efficacy, albeit by a small margin. The ERC guidelines point to studies showing unchanged termination rates of subsequent refibrillation when using fixed 120J or 150J shocks, only seeing positive results when an increased energy level (360 J) was selected.9 One study also found a slightly lower efficacy of a first shock at 120J compared with higher energy levels. It was reported that 150J-200J achieved an efficacy rate of 86-98%, while the first shock efficacy of the rectilinear biphasic (RLB) waveform using 120J was at 85%.10
In order to limit
the time spent in cardiac arrest and aim for the highest possible chances of success, it appears that higher energy levels and the type of waveform used may have a positive impact. An expert opinion in the ERC guidelines lends further weight to the efficacy of higher energy shock. The ERC said: “If the rescuer is unaware of the recommended
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