Optimizing defibrillation during cardiac arrest

Giovanni Babini, Laura Ruggeri, Giuseppe Ristagno

Research output: Contribution to journalReview articlepeer-review


Purpose of review Current cardiac arrest guidelines are based on a fixed, time-based defibrillation strategy. Rhythm analysis and shock delivery (if indicated) are repeated every 2min requiring cyclical interruptions of chest compressions. This approach has several downsides, such as the need to temporarily stop cardiopulmonary resuscitation (CPR) for a variable amount of time, thus reducing myocardial perfusion and decreasing the chance of successful defibrillation. A tailored defibrillation strategy should identify treatment priority for each patient, that is chest compressions (CCS) or defibrillation, minimize CCs interruptions, speed up the delivery of early effective defibrillation and reduce the number of ineffective shocks. Recent findings Real-time ECG analysis (using adaptive filters, new algorithms robust to chest compressions artifacts and shock-advisory algorithms) is an effective strategy to correctly identify heart rhythm during CPR and reduce the hands-off time preceding a shock. Similarly, ventricular fibrillation waveform analysis, that is amplitude spectrum area (AMSA) represents a well established approach to reserve defibrillation in patients with high chance of shock success and postpone it when ventricular fibrillation termination is unlikely. Both approaches demonstrated valuable results in improving cardiac arrest outcomes in experimental and observational study. Summary Real-time ECG analysis and AMSA have the potential to predict ventricular fibrillation termination, return of spontaneous circulation and even survival, with discretely high confidence. Prospective studies are now necessary to validate these new approaches in the clinical scenario.

Original languageEnglish
Pages (from-to)246-254
Number of pages9
JournalCurrent Opinion in Critical Care
Issue number3
Publication statusPublished - Jun 2021


  • Amplitude spectrum area
  • Cardiac arrest
  • Defibrillation
  • ECG analysis
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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