|Title:||Biphasic Defibrillation Energies|
|Document ID:||Operational Circular OP 1909/05|
|Date of issue:||Thursday, 3 February 2005|
|Status:||NO LONGER APPLICABLE|
|Description:||This Operational Circular is a guide to public hospitals and health services regarding the correct energies to use when defibrillating patients with defibrillators utilising a biphasic waveform.|
|Applicable to:||Clinical staff of public hospitals and health services.|
|Period of effect:||from 1 February 2005|
|Authorised by:||Dr Andrew Robertson, Group Director, Health Care and Disaster Preparedness, 01-Feb-2005|
|Print version:||View print version|
Biphasic Defibrillation Energies
In the clinical area, biphasic defibrillators are rapidly replacing monophasic defibrillators. Biphasic shocks appear to achieve the same defibrillation success rates as monophasic waveforms but at significantly lower energy levels. Unfortunately, the recommended energy levels for biphasic defibrillation in cases of Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (VT) vary according to the manufacturer of the defibrillator. There is no evidence of improved survival between the various recommended energy levels. However, differences in recommended energy levels may lead to confusion amongst clinicians.
Another innovation has been the advent of Automated External Defibrillators (AEDs) which are able to detect the nature of the rhythm and automatically administer a shock. AEDs generally use a biphasic waveform.
The Australian Resuscitation Council (ARC) has released an advisory statement regarding energy levels for biphasic defibrillation. This was published in the Medical Journal of Australia in October 20031 . The Department of Health, through the Critical Care Council, has reviewed and endorses this statement, the full text of which can be found either in the printed journal or at:
The advisory statement is also available on the ARC website:
The major recommendations of the ARC are:
When using manual biphasic defibrillators, energy levels of 150J should be used for defibrillating ventricular fibrillation and pulseless ventricular tachycardia in adults.
Biphasic energy levels of 1-2 joules per kg should be used for defibrillating ventricular fibrillation and pulseless ventricular tachycardia in children.
When purchasing automated external biphasic defibrillators, if the vendor offers an option to choose the energy levels prior to delivery, the manufacturers recommendations should be followed.
Hospitals and Health Services are advised to ensure that all clinical staff are familiar with the types of defibrillator located in clinical areas and have accessed appropriate training. The advice in this circular should be taken into account when resuscitating patients using biphasic defibrillators.
Dr Andrew Robertson
This circular last updated: Thursday, 3 February 2005 at 12:00am