Truncated exponential versus damped sinusoidal waveform shocks for transthoracic defibrillation

Currently available transthoracic defibrillators use either a damped sinusoidal or truncated exponential (TE) waveform. Truncated exponential waveforms deliver a long pulse if the transthoracic impedance is high; it has been suggested that such a long pulse may be less effective for defibrillation. Our objective was to compare the ability of damped sinusoidal (DS) waveform shocks versus TE waveform shocks to terminate ventricular fibrillation (VF) and achieve survival from witnessed cardiac arrest. We retrospectively reviewed field-recorded electrocardiograms from 86 patients with witnessed VF, treated by prehospital personnel equipped with DS or TE waveform defibrillators. Forty-four patients received 130 shocks from TE defibrillators; 42 patients received 108 shocks from DS defibrillators. There were no significant differences in time from arrest to first shock (8.0 vs 8.1 minutes), nor were there any differences in the size of the communities involved. The shocks resulted in the following rhythms: organized rhythm: TE: 15 of 130 (12%), DS: 24 of 108 (22%), p = 0.10 (NS); persistent VF: TE: 85 of 130 (65%), DS: 45 of 108 (42%), p < 0.01; asystole: TE: 30 of 130 (23%), DS: 39 of 108 (36%), p = NS; and survival to hospital discharge: TE: 5 of 44 (11%), DS: 8 of 42 (19%), p = NS. We conclude that DS waveforms terminated VF more frequently than TE, but there was no significant difference in resumption of an organized rhythm or survival. A prospective comparison of these 2 waveforms is needed.