Recent advances in external cardiac defibrillation techniques_Journal of Biomedical Engineering

Authors：

LI Weiming ¹ , XIE Jialing ¹ , PENG Li ¹ , WEI Liang ¹ , WANG Shuangwei ² ,  LI Yongqin ¹

1. Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing 400038, P.R.China;
2. Shenzhen Dashen Institute of Biomedical Engineering Translation, Shenzhen, Guangdong 518060, P.R.China;

Corresponding author：

Keywords：

cardiac arrest; malignant arrhythmia; ventricular fibrillation; external defibrillation

DOI：

10.7507/1001-5515.202003013

Video：

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As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.

Citation： LI Weiming, XIE Jialing, PENG Li, WEI Liang, WANG Shuangwei, LI Yongqin. Recent advances in external cardiac defibrillation techniques. Journal of Biomedical Engineering, 2020, 37(6): 1095-1100. doi: 10.7507/1001-5515.202003013 Copy

1.	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告 2018》概要. 中国循环杂志, 2019, 34(3): 209-220.
2.	刘光明. 室性心律失常的评估和决策. 世界最新医学信息文摘, 2019, 19(105): 64-65.
3.	Rajan S, Folke F, Hansen S M, et al. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation, 2017, 114: 157-163.
4.	Huang Y, Wen X, Wang J, et al. Toward miniaturization of defibrillators: design of a defibrillation charge/discharge circuit. Conf Proc IEEE Eng Med Biol Soc, 2019, 2019: 6155-6158.
5.	徐津申. 自动体外除颤仪在急诊心搏骤停患者救治中的应用. 医疗装备, 2019, 32(2): 29-30.
6.	Okamura H, Desimone C V, Killu A M, et al. Evaluation of a unique defibrillation unit with dual-vector biphasic waveform capabilities: towards a miniaturized defibrillator. Pacing Clin Electrophysiol, 2017, 40(2): 108-114.
7.	Dosdall D J, Fast V G, Ideker R E. Mechanisms of defibrillation. Annu Rev Biomed Eng, 2010, 12: 233-258.
8.	Bragard J, Sankarankutty A C, Sachse F B. Extended bidomain modeling of defibrillation: quantifying virtual electrode strengths in fibrotic myocardium. Front Physiol, 2019, 10: 337.
9.	吕鹏飞, 叶继伦, 张旭, 等. 体外除颤技术及应用研究进展. 中国医疗器械杂志, 2018, 43(3): 188-192.
10.	Yin C, Chen B, Gao L, et al. History, principle and techniques for waveform optimization in external defibrillations. Recent Patents on Engineering, 2012, 6: 20-30.
11.	Schmidt A S, Lauridsen K G, Adelborg K, et al. Cardioversion efficacy using pulsed biphasic or biphasic truncated exponential waveforms: a randomized clinical trial. J Am Heart Assoc, 2017, 6(3): e004853.
12.	Huang J, Ruse R B, Walcott G P, et al. Ascending defibrillation waveform significantly reduces myocardial morphological damage and injury current. JACC Clin Electrophysiol, 2019, 5(7): 854-862.
13.	Varghese F, Neuber J U, Xie F, et al. Low-energy defibrillation with nanosecond electric shocks. Cardiovasc Res, 2017, 113(14): 1789-1797.
14.	Semenov I, Grigoryev S, Neuber J U, et al. Excitation and injury of adult ventricular cardiomyocytes by nano-to millisecond electric shocks. Sci Rep, 2018, 8(1): 8233.
15.	Mercier E, Laroche E, Beck B, et al. Defibrillation energy dose during pediatric cardiac arrest: Systematic review of human and animal model studies. Resuscitation, 2019, 139: 241-252.
16.	Anantharaman V, Tay S Y, Manning P G, et al. A multicenter prospective randomized study comparing the efficacy of escalating higher biphasic versus low biphasic energy defibrillations in patients presenting with cardiac arrest in the in-hospital environment. Open Access Emerg Med, 2017, 9: 9-17.
17.	Patel K K, Spertus J A, Khariton Y, et al. Association between prompt defibrillation and epinephrine treatment with long-term survival after in-hospital cardiac arrest. Circulation, 2018, 137(19): 2041-2051.
18.	Bircher N G, Chan P S, Xu Y; American Heart Association’s Get With The Guidelines-Resuscitation Investigators. Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest. Anesthesiology, 2019, 130(3): 414-422.
19.	Chen B, Yin C, Ristagno G, et al. Retrospective evaluation of current-based impedance compensation defibrillation in out-of-hospital cardiac arrest. Resuscitation, 2013, 84(5): 580-585.
20.	Sadek M M, Chaugai V, Cleland M J, et al. Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter. Clin Cardiol, 2018, 41(5): 666-670.
21.	Ristagno G, Yu T, Quan W, et al. Current is better than energy as predictor of success for biphasic defibrillatory shocks in a porcine model of ventricular fibrillation. Resuscitation, 2013, 84(5): 678-683.
22.	Chen B, Yu T, Ristagno G, et al. Average current is better than peak current as therapeutic dosage for biphasic waveforms in a ventricular fibrillation pig model of cardiac arrest. Resuscitation, 2014, 85(10): 1399-1404.
23.	Anantharaman V, Wan P W, Tay S Y, et al. Role of peak current in conversion of patients with ventricular fibrillation. Singapore Med J, 2017, 58(7): 432-437.
24.	Jin D, Dai C, Gong Y, et al. Does the choice of definition for defibrillation and CPR success impact the predictability of ventricular fibrillation waveform analysis?. Resuscitation, 2017, 111: 48-54.
25.	Balderston J R, Gertz Z M, Ellenbogen K A, et al. Association between ventricular fibrillation amplitude immediately prior to defibrillation and defibrillation success in out-of-hospital cardiac arrest. Am Heart J, 2018, 201: 72-76.
26.	Hagihara A, Onozuka D, Ono J, et al. Interaction of defibrillation waveform with the time to defibrillation or the number of defibrillation attempts on survival from out-of-hospital cardiac arrest. Resuscitation, 2018, 122: 54-60.
27.	Hulleman M, Salcido D D, Menegazzi J J, et al. Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest. Resuscitation, 2017, 120: 125-131.
28.	Horie T, Burioka N, Amisaki T, et al. Sample entropy in electrocardiogram during atrial fibrillation. Yonago Acta Med, 2018, 61(1): 49-57.
29.	Yang Q, Li M, Huang Z, et al. Validation of spectral energy for the quantitative analysis of ventricular fibrillation waveform to guide defibrillation in a porcine model of cardiac arrest and resuscitation. J Thorac Dis, 2019, 11(9): 3853-3863.
30.	Thannhauser J, Nas J, van Grunsven P M, et al. The ventricular fibrillation waveform in relation to shock success in early vs. late phases of out-of-hospital resuscitation. Resuscitation, 2019, 139: 99-105.
31.	Coult J, Kwok H, Sherman L, et al. Ventricular fibrillation waveform measures combined with prior shock outcome predict defibrillation success during cardiopulmonary resuscitation. J Electrocardiol, 2018, 51(1): 99-106.
32.	Coult J, Blackwood J, Sherman L, et al. Ventricular fibrillation waveform analysis during chest compressions to predict survival from cardiac arrest. Circ Arrhythm Electrophysiol, 2019, 12(1): e006924.
33.	Nakagawa Y, Amino M, Inokuchi S, et al. Novel CPR system that predicts return of spontaneous circulation from amplitude spectral area before electric shock in ventricular fibrillation. Resuscitation, 2017, 113: 8-12.
34.	Cay S, Ozcan F, Ozeke O, et al. Defibrillation failure: Considerations. J Arrhythm, 2018, 4(3): 333-334.
35.	Kuschner C E, Becker L B. Recent advances in personalizing cardiac arrest resuscitation. F1000Res, 2019, 8: F1000 Faculty Rev-915.
36.	Schuger C. Is the best (waveform) the enemy of the good (waveform)? A defibrillation challenge. JACC Clin Electrophysiol, 2019, 5(7): 863-864.
37.	Shanmugasundaram M, Lotun K. Refractory out of hospital cardiac arrest. Curr Cardiol Rev, 2018, 14(2): 109-114.
38.	Nichol G, Sayre M R, Guerra F, et al. Defibrillation for ventricular fibrillation: a shocking update. J Am Coll Cardiol, 2017, 70(12): 1496-1509.
39.	Simon E M, Tanaka K. Double sequential defibrillation. Cardiol Clin, 2018, 36(3): 387-393.
40.	Cheskes S, Dorian P, Feldman M, et al. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 2020, pii: S0300-9572(20)30074-5.
41.	Antoneli P C, Goulart J T, Bonilha I, et al. Heart defibrillation: relationship between pacing threshold and defibrillation probability. Biomed Eng Online, 2019, 18(1): 96.
42.	Aiello S, Perez M, Cogan C, et al. Real-time ventricular fibrillation amplitude-spectral area analysis to guide timing of shock delivery improves defibrillation efficacy during cardiopulmonary resuscitation in swine. J Am Heart Assoc, 2017, 6(11): e006749.

1. 胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告 2018》概要. 中国循环杂志, 2019, 34(3): 209-220.
2. 刘光明. 室性心律失常的评估和决策. 世界最新医学信息文摘, 2019, 19(105): 64-65.
3. Rajan S, Folke F, Hansen S M, et al. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation, 2017, 114: 157-163.
4. Huang Y, Wen X, Wang J, et al. Toward miniaturization of defibrillators: design of a defibrillation charge/discharge circuit. Conf Proc IEEE Eng Med Biol Soc, 2019, 2019: 6155-6158.
5. 徐津申. 自动体外除颤仪在急诊心搏骤停患者救治中的应用. 医疗装备, 2019, 32(2): 29-30.
6. Okamura H, Desimone C V, Killu A M, et al. Evaluation of a unique defibrillation unit with dual-vector biphasic waveform capabilities: towards a miniaturized defibrillator. Pacing Clin Electrophysiol, 2017, 40(2): 108-114.
7. Dosdall D J, Fast V G, Ideker R E. Mechanisms of defibrillation. Annu Rev Biomed Eng, 2010, 12: 233-258.
8. Bragard J, Sankarankutty A C, Sachse F B. Extended bidomain modeling of defibrillation: quantifying virtual electrode strengths in fibrotic myocardium. Front Physiol, 2019, 10: 337.
9. 吕鹏飞, 叶继伦, 张旭, 等. 体外除颤技术及应用研究进展. 中国医疗器械杂志, 2018, 43(3): 188-192.
10. Yin C, Chen B, Gao L, et al. History, principle and techniques for waveform optimization in external defibrillations. Recent Patents on Engineering, 2012, 6: 20-30.
11. Schmidt A S, Lauridsen K G, Adelborg K, et al. Cardioversion efficacy using pulsed biphasic or biphasic truncated exponential waveforms: a randomized clinical trial. J Am Heart Assoc, 2017, 6(3): e004853.
12. Huang J, Ruse R B, Walcott G P, et al. Ascending defibrillation waveform significantly reduces myocardial morphological damage and injury current. JACC Clin Electrophysiol, 2019, 5(7): 854-862.
13. Varghese F, Neuber J U, Xie F, et al. Low-energy defibrillation with nanosecond electric shocks. Cardiovasc Res, 2017, 113(14): 1789-1797.
14. Semenov I, Grigoryev S, Neuber J U, et al. Excitation and injury of adult ventricular cardiomyocytes by nano-to millisecond electric shocks. Sci Rep, 2018, 8(1): 8233.
15. Mercier E, Laroche E, Beck B, et al. Defibrillation energy dose during pediatric cardiac arrest: Systematic review of human and animal model studies. Resuscitation, 2019, 139: 241-252.
16. Anantharaman V, Tay S Y, Manning P G, et al. A multicenter prospective randomized study comparing the efficacy of escalating higher biphasic versus low biphasic energy defibrillations in patients presenting with cardiac arrest in the in-hospital environment. Open Access Emerg Med, 2017, 9: 9-17.
17. Patel K K, Spertus J A, Khariton Y, et al. Association between prompt defibrillation and epinephrine treatment with long-term survival after in-hospital cardiac arrest. Circulation, 2018, 137(19): 2041-2051.
18. Bircher N G, Chan P S, Xu Y; American Heart Association’s Get With The Guidelines-Resuscitation Investigators. Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest. Anesthesiology, 2019, 130(3): 414-422.
19. Chen B, Yin C, Ristagno G, et al. Retrospective evaluation of current-based impedance compensation defibrillation in out-of-hospital cardiac arrest. Resuscitation, 2013, 84(5): 580-585.
20. Sadek M M, Chaugai V, Cleland M J, et al. Association between transthoracic impedance and electrical cardioversion success with biphasic defibrillators: An analysis of 1055 shocks for atrial fibrillation and flutter. Clin Cardiol, 2018, 41(5): 666-670.
21. Ristagno G, Yu T, Quan W, et al. Current is better than energy as predictor of success for biphasic defibrillatory shocks in a porcine model of ventricular fibrillation. Resuscitation, 2013, 84(5): 678-683.
22. Chen B, Yu T, Ristagno G, et al. Average current is better than peak current as therapeutic dosage for biphasic waveforms in a ventricular fibrillation pig model of cardiac arrest. Resuscitation, 2014, 85(10): 1399-1404.
23. Anantharaman V, Wan P W, Tay S Y, et al. Role of peak current in conversion of patients with ventricular fibrillation. Singapore Med J, 2017, 58(7): 432-437.
24. Jin D, Dai C, Gong Y, et al. Does the choice of definition for defibrillation and CPR success impact the predictability of ventricular fibrillation waveform analysis?. Resuscitation, 2017, 111: 48-54.
25. Balderston J R, Gertz Z M, Ellenbogen K A, et al. Association between ventricular fibrillation amplitude immediately prior to defibrillation and defibrillation success in out-of-hospital cardiac arrest. Am Heart J, 2018, 201: 72-76.
26. Hagihara A, Onozuka D, Ono J, et al. Interaction of defibrillation waveform with the time to defibrillation or the number of defibrillation attempts on survival from out-of-hospital cardiac arrest. Resuscitation, 2018, 122: 54-60.
27. Hulleman M, Salcido D D, Menegazzi J J, et al. Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest. Resuscitation, 2017, 120: 125-131.
28. Horie T, Burioka N, Amisaki T, et al. Sample entropy in electrocardiogram during atrial fibrillation. Yonago Acta Med, 2018, 61(1): 49-57.
29. Yang Q, Li M, Huang Z, et al. Validation of spectral energy for the quantitative analysis of ventricular fibrillation waveform to guide defibrillation in a porcine model of cardiac arrest and resuscitation. J Thorac Dis, 2019, 11(9): 3853-3863.
30. Thannhauser J, Nas J, van Grunsven P M, et al. The ventricular fibrillation waveform in relation to shock success in early vs. late phases of out-of-hospital resuscitation. Resuscitation, 2019, 139: 99-105.
31. Coult J, Kwok H, Sherman L, et al. Ventricular fibrillation waveform measures combined with prior shock outcome predict defibrillation success during cardiopulmonary resuscitation. J Electrocardiol, 2018, 51(1): 99-106.
32. Coult J, Blackwood J, Sherman L, et al. Ventricular fibrillation waveform analysis during chest compressions to predict survival from cardiac arrest. Circ Arrhythm Electrophysiol, 2019, 12(1): e006924.
33. Nakagawa Y, Amino M, Inokuchi S, et al. Novel CPR system that predicts return of spontaneous circulation from amplitude spectral area before electric shock in ventricular fibrillation. Resuscitation, 2017, 113: 8-12.
34. Cay S, Ozcan F, Ozeke O, et al. Defibrillation failure: Considerations. J Arrhythm, 2018, 4(3): 333-334.
35. Kuschner C E, Becker L B. Recent advances in personalizing cardiac arrest resuscitation. F1000Res, 2019, 8: F1000 Faculty Rev-915.
36. Schuger C. Is the best (waveform) the enemy of the good (waveform)? A defibrillation challenge. JACC Clin Electrophysiol, 2019, 5(7): 863-864.
37. Shanmugasundaram M, Lotun K. Refractory out of hospital cardiac arrest. Curr Cardiol Rev, 2018, 14(2): 109-114.
38. Nichol G, Sayre M R, Guerra F, et al. Defibrillation for ventricular fibrillation: a shocking update. J Am Coll Cardiol, 2017, 70(12): 1496-1509.
39. Simon E M, Tanaka K. Double sequential defibrillation. Cardiol Clin, 2018, 36(3): 387-393.
40. Cheskes S, Dorian P, Feldman M, et al. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 2020, pii: S0300-9572(20)30074-5.
41. Antoneli P C, Goulart J T, Bonilha I, et al. Heart defibrillation: relationship between pacing threshold and defibrillation probability. Biomed Eng Online, 2019, 18(1): 96.
42. Aiello S, Perez M, Cogan C, et al. Real-time ventricular fibrillation amplitude-spectral area analysis to guide timing of shock delivery improves defibrillation efficacy during cardiopulmonary resuscitation in swine. J Am Heart Assoc, 2017, 6(11): e006749.

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Recent advances in external cardiac defibrillation techniques

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