Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims

Background-In the present study, we compared an automatic external defibril lator (AED) that delivers 150-J biphasic shocks with traditional high-energ y (200- to 360-J) monophasic AEDs. Methods and Results-AEDs were prospectively randomized according to defibri llation waveform on a daily basis in 4 emergency medical services systems. Defibrillation efficacy, survival to hospital admission and discharge, retu rn of spontaneous circulation, and neurological status at discharge (cerebr al performance category) were compared. Of 338 patients with out-of-hospita l cardiac arrest, 115 had a cardiac etiology, presented with ventricular fi brillation, and were shocked with an AED. The time from the emergency call to the first shack was 8.9+/-3.0 (mean+/-SD) minutes. Conclusions-The 150-J biphasic waveform defibrillated at higher rates, resu lting in more patients who achieved a return of spontaneous circulation. Al though survival rates to hospital admission and discharge did not differ, d ischarged patients who had been resuscitated with biphasic shocks were more likely to have good cerebral performance.