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Most commercially available biphasic automated external defibrillators (AEDs) have initial shock energies of 150 to 200 J. However, it is unclear whether escalation of energy levels confers any additional benefit in cases of resistant ventricular fibrillation (VF). In a Canadian prospective treatment trial funded by an AED manufacturer, individuals who had out-of-hospital cardiac arrest were randomized to receive fixed-energy (150–150–150 J) or escalating-energy (200–300–360 J) biphasic defibrillation.
The researchers analyzed data from 221 patients (114 in the fixed-energy group and 107 in the escalating-energy group). In about half of both groups, VF was terminated or successfully converted on the first shock. Among the 106 patients who re…