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Monophasic or biphasic defibrillation
  1. Russell Boyd,
  2. Angaj Ghosh
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

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    Report by Russell Boyd, Consultant Search checked by Angaj Ghosh, Senior Clinical Fellow

    Clinical scenario

    You have just finished an unsuccessful cardiac resuscitation in a patient who had an initial presenting rhythm of ventricular fibrillation. You wonder if one of the new biphasic defibrillators would have increased the possibility of successful defibrillation.

    Three part question

    In [an adult patient with ventricular fibrillation] is [biphasic or monophasic D/C shock] better [at restoring sinus rhythm]?

    Search strategy

    Medline 1966–11/00 using the OVID interface. (biphasic.mp OR monophasic.mp) AND (exp.defibrillation OR exp electric counter shock OR cardioversion.mp).

    Search outcome

    Altogether 316 papers found of which 313 were irrelevant or of insufficient quality. The remaining three papers are shown in table 7.

    Table 7

    Comments

    There is some laboratory evidence that biphasic defibrillation has higher first shock success rates for defibrillation of VF/VT. A theoretical advantage exists with biphasic devices but there is no clinical evidence of increased survival in cardiac arrest occurring outside the cardiac arrhythmia laboratory.

    Clinical bottom line

    The advantages of biphasic devices are currently mainly theoretical. No real world data exist that would suggest an immediate conversion to using biphasic devices.

    Report by Russell Boyd, Consultant Search checked by Angaj Ghosh, Senior Clinical Fellow

    References

    View Abstract

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