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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Variations of shock efficacy and refibrillation in different AED user groups.

Shujie Chen1, Chenguang Liu1, Stacy Gehman1

  • 1Philips, 22100 Bothell Everett Hwy, Bothell, WA 98021, USA.

Resuscitation
|September 25, 2025
PubMed
Summary

Lay responders using automated external defibrillators (AEDs) showed higher shock success and lower refibrillation rates in out-of-hospital cardiac arrest (OHCA) compared to trained first responders and EMS. These findings highlight user experience impacts on AED effectiveness.

Keywords:
Amplitude spectrum area (AMSA)Automated external defibrillator (AED) use scenariosOut-of-hospital cardiac arrest (OHCA)RefibrillationShock efficacyShock impedance

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Biomedical Engineering

Background:

  • Automated external defibrillator (AED) use in out-of-hospital cardiac arrest (OHCA) is critical, with outcomes influenced by user type and time to shock.
  • Understanding variations in AED shock efficacy and refibrillation rates across different user groups is essential for improving survival rates.

Purpose of the Study:

  • To compare the shock efficacy and refibrillation rates of AEDs used by lay responders, trained first responders, and emergency medical services (EMS).
  • To analyze factors influencing AED outcomes, including amplitude spectrum area (AMSA) and shock impedance.

Main Methods:

  • Analysis of ECG data from 2358 adult OHCA cases in the US and Europe using three AED models (HS1, FRx, FR3).
  • Grouping cases by AED user: lay-responder (HS1), trained first-responder (FRx), and EMS (FR3).
  • Comparison of shock success and refibrillation rates, with regression analyses for AMSA and shock impedance associations.

Main Results:

  • Overall shock efficacy was highest in lay-responders (95.0%), followed by trained first-responders (94.0%), and EMS (86.6%) (p < 0.001).
  • First shock efficacy also favored lay-responders (96.9%) over trained first-responders (94.5%) and EMS (89.0%) (p = 0.007).
  • Refibrillation rates varied significantly (p = 0.016), with higher AMSA associated with reduced refibrillation (HR, 0.95). Shock impedance did not correlate with efficacy or refibrillation.

Conclusions:

  • Low-energy biphasic shocks from AEDs are highly effective across various user scenarios, independent of shock impedance.
  • Lay responders demonstrated superior shock efficacy and lower refibrillation rates compared to trained first responders and EMS, potentially due to shorter response times.
  • While AMSA influences refibrillation, other factors likely contribute to observed differences in AED outcomes among user groups.