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Death and damage caused by multiple direct current shocks: studies in an animal model
C M Wilson1, J D Allen, J B Bridges
1Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland.
European Heart Journal
|November 1, 1988
Summary
Multiple high-energy defibrillator shocks increase mortality and cardiac damage in dogs. A single shock is well tolerated, but multiple shocks lead to pump failure, highlighting the need for optimized first-shock effectiveness.
Area of Science:
- Cardiology
- Veterinary Medicine
- Electrophysiology
Background:
- Patients requiring multiple defibrillator shocks often have a poor prognosis.
- The cardiac effects of multiple high-energy transthoracic shocks are not fully understood.
- Acute mortality and cardiac damage following defibrillation require further investigation.
Purpose of the Study:
- To evaluate the effects of single versus multiple high-energy transthoracic shocks on acute mortality and cardiac function in healthy greyhounds.
- To assess myocardial damage and contractile failure following escalating doses of defibrillation.
- To provide insights into patient outcomes after multiple defibrillator shocks.
Main Methods:
- Healthy greyhounds received one, five, or ten 400 J transthoracic shocks.
- Acute mortality was recorded, with causes of death analyzed (asystole, electromechanical dissociation).
- Myocardial tissue was examined via electron microscopy; cardiac damage was quantified macroscopically in survivors.
Main Results:
- Acute mortality significantly increased with the number of shocks administered (one shock: 0/6; five shocks: 8/18; ten shocks: 12/17).
- Survivors receiving multiple shocks showed significant ST segment elevation and greater macroscopic cardiac damage compared to single-shock recipients.
- Electron microscopy revealed few specific myocardial abnormalities despite significant contractile failure.
Conclusions:
- A single high-energy defibrillator shock is well tolerated in this greyhound model.
- Multiple shocks cause significant cardiac injury, leading to acute pump failure and increased mortality.
- These findings underscore the need to re-evaluate mortality causes in patients receiving multiple shocks and emphasize optimizing first-shock success.
