Survival to discharge following a cardiac arrest is dependent on rapid and effective basic and advanced life support. As stated in the latest guideline of the American Heart Association (AHA, 2010), healthcare providers who treat cardiac arrest in hospital should use the defibrillator or other facilities with automated external defibrillators to provide immediate cardiopulmonary resuscitation. Defibrillation plays an important role in restoring normal electrical rhythm and natural pacemaker control to the heart from chaotic heart rhythm such as ventricular fibrillation or pulseless ventricular tachycardia. This dissertation aims to identify the best evidence and develop an evidence-based guideline of defibrillation for cardiac arrest patients. The objectives of this thesis are to conduct a search of available literatures on defibrillation, mainly focusing on the defibrillation waveform and energy level, perform a critical appraisal on the literature, establish tables of evidence, and develop recommendations and defibrillation protocol for cardiac arrest patients. A systematic search was performed using four electronic databases, including PubMed, Ovid Medicine, CINAHL and the journal Resuscitation. Six randomized controlled studies were selected from thousands of related studies which fulfilled the inclusion criteria of this dissertation. Data were extracted by tables of evidence and critical appraisal was performed. Also, the level of evidence for each study was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) framework. By synthesizing the data from the six selected studies, the biphasic waveform with 200J as the first shock energy and 200J-300J-360J as subsequent shocks was shown to help to achieve more desirable clinical outcomes to cardiac patients. The implementation potential, including transferability, feasibility and cost/ benefit ratio of the innovation, was assessed, and the evidence-based practice protocol are beneficial for cardiac arrest patients. Also, a comprehensive implementation plan was demonstrated by discussing communication between different stakeholders and transitions the practice from initiation to guiding and sustaining stage. Pilot testing would be carried out to explore any unexpected technical and logistic issues that could be avoided in the full-scale implementation of the innovation. A full evaluation plan concerning patient outcomes, healthcare provider outcomes and system outcomes would then formulated and demonstrated in the end of this dissertation. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (Ph. D.)--University of Washington, 1994. / Vita. Includes bibliographical references (leaves [159]-165).

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2006. / Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Thesis (M.Eng.). / Written for the Dept. of Electrical and Computer Engineering. Title from title page of PDF (viewed 2008/05/13). Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1991.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010. / Härtill 5 uppsatser.

Orientador: Orlando Petrucci Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T07:48:01Z (GMT). No. of bitstreams: 1 Assumpcao_AntonioCarlos_D.pdf: 13951044 bytes, checksum: 4ebd9040bcd7ea540e6927bdc4258384 (MD5) Previous issue date: 2013 / Resumo: Introdução: O aumento do limiar de estimulação ventricular (LEV) tem sido observado após a administração de choque elétrico de cardioversão/desfibrilação transtorácico (CDT) para desfibrilação ventricular, contudo, poucos estudos têm avaliado este fenômeno no que diz respeito à energia e a forma de onda empregada para a CDT. Este estudo analisou o LEV após CDT de 360J, comparando-se os resultados após aplicação de onda de energia Mono e Bi. Método: Em suínos Landrace femininos foram implantados sistema de estimulação permanente de marcapasso, divididos em três grupos: sem indução de fibrilação ventricular (FV) e CDT com formato de onda monofásica (Mono) e bifásica (Bi) (Grupo I); indução FV, um minuto de observação sem intervenção, dois minutos de massagem cardíaca externa, e CDT Mono e Bi (Grupo II) e indução de FV, dois minutos de observação sem intervenção, quatro minutos de massagem cardíaca externa e CDT Mono e Bi (Grupo III). Após CDT, o LEV foi avaliado a cada minuto durante dez minutos. Resultados: Um total de 143 experimentos foram concluídos. No final do período de observação, os grupos I e II mostraram valores constantes LEV. O Grupo III mostrou aumento no LEV Mono e Bi com energia externa, sem diferença entre os formatos de ondas externas. O formato Mono foi associada a valores mais elevados de LEV quando o tempo de parada cardiorrespiratória (PCR) foi maior, o que não foi verificado na Bi. Conclusão: A CDT não tem impacto significativo sobre o LEV. Com onda Mono, observou-se aumento do LEV quando o período de PCR foi mais longo / Abstract: Introduction. Although an increase in the ventricular pacing threshold (VPT) has been observed after administration of transthoracic shock for ventricular defibrillation, few studies have evaluated the phenomenon in respect to the defibrillation waveform energy. Therefore, this study examined the VPT behavior after transthoracic shock with a monophasic or biphasic energy waveform. Method. Domestic Landrace female piglets implanted with a permanent pacemaker stimulation system were divided into 3 groups: no ventricular fibrillation (VF) induction and transthoracic shock with monophasic or biphasic energy (group I); VF induction, 1 minute of observation without intervention, 2 minutes of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group II); and VF induction, 2 minutes of observation without intervention, 4 minutes of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group III). After external shock, the VPT was evaluated every minute for 10 minutes. Results. A total of 143 experiments were performed. At the end of the observation period, groups I and II showed steady VPT values. Group III showed an increase in VPT with monophasic or biphasic external energy, with no difference between the external energy sources. The monophasic but not the biphasic waveform was associated with higher VPT values when the VF was longer. Conclusion. Defibrillation does not have a significant impact on pacing threshold, but a longer VF period is related to a higher VPT after defibrillation with monophasic waveform / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências