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      Transthoracic impedance does not affect defibrillation, resuscitation or survival in patients with out-of-hospital cardiac arrest treated with a non-escalating biphasic waveform defibrillator.


      Cardiography, Impedance, statistics & numerical data, Defibrillators, Electric Countershock, instrumentation, Emergency Medical Services, methods, Heart Arrest, epidemiology, therapy, Humans, Minnesota, North Carolina, Outcome and Process Assessment (Health Care), Resuscitation, Retrospective Studies, Survival Analysis, Treatment Outcome

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          This is a study of the influence of transthoracic impedance (TTI) on defibrillation, resuscitation and survival in patients with out-of-hospital cardiac arrest (OHCA), treated with a non-escalating impedance-compensating 150 J biphasic waveform defibrillator. Cardiac arrest data from two EMS systems were analyzed retrospectively. All witnessed arrests from patients who presented with a shockable rhythm and were treated initially by BLS personnel were included (n = 102). For each defibrillation and resuscitation outcome variable, we tested differences in mean TTI for successful versus unsuccessful outcome. The effect of call-to-shock time on overall outcome was also examined. Initial shocks defibrillated 90% [83-95%] (95% confidence interval) of patients. Cumulative success with two shocks was 98% [93-100%] and with three shocks was 99% [95-100%]. TTI averaged 90 +/- 23 Omega. First-shock success, cumulative success through two shocks and cumulative success through the first-shock series were unrelated to TTI, as were BLS ROSC, pre-hospital ROSC, hospital admission and discharge. In contrast and consistent with previous findings, call-to-shock time was highly predictive of survival. High impedance patients were defibrillated by the biphasic waveform used in this study at high rates with a fixed energy of 150 J and without energy escalation. Rapid defibrillation rather than differences in patient impedance accounts for resuscitation success.

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