External Cardioversion-Defibrillation with Pushing Down on the Chest Wall to Increase the Success Rate in Obese Patients

BACKGROUND The energy delivered by a defibrillator is expressed in joules (J). However, current is what actually defibrillates the heart and is related to the voltage-to-impedance ratio. With the same energy, the lower the transthoracic impedance, the higher the current delivered. In obese patients,...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of case reports 2020-11, Vol.21, p.e927009-e927009
Main Authors: Young, Ming-Lon, Exelbert, Eric J, Roth, Todd, Cohen, Lance, Cogan, John
Format: Article
Language:English
Subjects:
Adolescent
Aged
Amiodarone
Atrial Fibrillation - therapy
Electric Countershock
Female
Humans
Male
Middle Aged
Obesity - complications
Obesity - therapy
Thoracic Wall
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:BACKGROUND The energy delivered by a defibrillator is expressed in joules (J). However, current is what actually defibrillates the heart and is related to the voltage-to-impedance ratio. With the same energy, the lower the transthoracic impedance, the higher the current delivered. In obese patients, pushing the chest wall toward the heart during electric shock can result in an improved outcome. CASE REPORT We report the cases of 3 obese patients with previously failed cardioversion/defibrillation who had an eventual shock success. (1) A 17-year-old girl failed multiple defibrillation efforts for her recurrent ventricular fibrillation. After ECMO, with the physician pushing down the chest wall, a 200-J defibrillation converted her VF. (2) A 63-year-old man with recurrent atrial fibrillation (AF) had an unsuccessful 150-J shock followed by a successful 200-J cardioversion. His AF recurred. After amiodarone bolus, a 200-J shock converted it to sinus. Another recurrent AF failed 150-J cardioversion. With chest pushing down, a 150-J cardioversion was successful. (3) A 65-year-old man underwent elective cardioversion for AF. A 200-J shock was unsuccessful. A 200-J shock with pressure on the chest successfully converted it. CONCLUSIONS We performed successful electrical cardioversion/defibrillation with this "pushing down the chest while shocking" method. Many clinicians are still unaware of this method, especially in obese patients. With the increasing prevalence of obesity, it is urgent to perform a randomized study to confirm the efficacy and safety of this method, and integrate it into advanced cardiac life support protocols.
ISSN:1941-5923
1941-5923
DOI:10.12659/AJCR.927009