The Present and Future
State-of-the-Art Review
Defibrillation for Ventricular Fibrillation: A Shocking Update

https://doi.org/10.1016/j.jacc.2017.07.778Get rights and content
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Abstract

Cardiac arrest is defined as the termination of cardiac activity associated with loss of consciousness, of spontaneous breathing, and of circulation. Sudden cardiac arrest and sudden cardiac death (SCD) are terms often used interchangeably. Most patients with out-of-hospital cardiac arrest have shown coronary artery disease or symptoms during the hour before the event. Cardiac arrest is potentially reversible by cardiopulmonary resuscitation, defibrillation, cardioversion, cardiac pacing, or treatments targeted at the underlying disease (e.g., acute coronary occlusion). We restrict SCD hereafter to cardiac arrest due to ventricular fibrillation, including rhythms shockable by an automatic external defibrillator (AED), implantable cardioverter-defibrillator (ICD), or wearable cardioverter-defibrillator (WCD). We summarize the state of the art related to defibrillation in treating SCD, including a brief history of the evolution of defibrillation, technical characteristics of modern AEDs, strategies to improve AED access and increase survival, ancillary treatments, and use of ICDs or WCDs.

Key Words

automated external defibrillator
cardiac arrhythmias
cardiopulmonary resuscitation
emergency medical services
out-of-hospital cardiac arrest
volunteers

Abbreviations and Acronyms

AED
automated external defibrillator
CPR
cardiopulmonary resuscitation
ECG
electrocardiography
EMS
emergency medical services
ICD
implantable cardioverter-defibrillator
LVEF
left ventricular ejection fraction
OHCA
out-of-hospital cardiac arrest
PSAP
public safety answering point
SCD
sudden cardiac death
VF
ventricular fibrillation
VT
ventricular tachycardia
WCD
wearable cardioverter-defibrillator

Cited by (0)

Dr. Nichol has received funding from the U.S. Food and Drug Administration and from Zoll Medical Corp. as principal investigator for the Dynamic Automatic External Defibrillator Registry; and has consulted for Zoll Circulation Inc. Dr. Sayre has received travel reimbursement from Physio-Control Inc. Dr. Poole is a compensated consultant for Kestra Inc.; and has received honoraria and travel reimbursement from Biotronik, Boston Scientific, Abbott, and Medtronic; and has received honoraria, travel fees, and research funding from Boston Scientific. Dr. Guerra has reported that he has no relationships relevant to the contents of this paper to disclose. Kalyanam Shivkumar, MD, PhD, served as Guest Editor for this paper.

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