Indications for External Defibrillation | Wellbeing

1. Indications for Defibrillation?

All tachyarrhythmias causing circulatory arrest, loss of consciousness, or severe hemodynamic compromise are indicated for emergency external defibrillation. This technique must be performed as quickly as possible if tachyarrhythmia patterns are recorded. Indications for defibrillation are applied in emergency situations when patients encounter heart problems, specifically:

Indications for defibrillation regarding dangerous heart rhythm disorders: Including:

• Ventricular Tachycardia: This is a cause of hemodynamic compromise. Perform the shock with an initial energy level of 100J, followed by 150J, and a maximum of 200J.
• Ventricular Fibrillation: This condition occurs when the heart muscles contract without coordination, causing the heart to not pump blood effectively. This is a common cause of circulatory arrest. The sooner defibrillation occurs, the better the chance for the patient. The maximum shock level is 360J if the first shock at 200J and the second at 300J were ineffective. If defibrillation is unsuccessful, continuous resuscitation, chest compressions combined with artificial ventilation must be performed immediately.
• Atrial Fibrillation: This is one of the common heart rhythm disorders. Perform emergency cardioversion for patients showing signs of hemodynamic instability due to atrial fibrillation, where the ventricular rate cannot be controlled despite optimal treatment with anti-arrhythmic drugs. Or in cases where the patient shows clinical signs of heart failure: hepatomegaly, jugular venous distention, hypotension, dyspnea. The shock aims to restore natural sinus rhythm for chronic atrial fibrillation patients with a low recurrence index after shock, to reduce the risk of thrombosis and embolism from blood clot formation in the heart due to atrial fibrillation.

• Risks: Defibrillation can cause skin burns or other cardiovascular problems if not performed correctly. Sometimes it can cause arrhythmias or other complications. Some complications such as respiratory failure, hypotension, cardiac injury, and acute pulmonary edema may occur.

• Contraindications: For ventricular tachycardia due to digitalis toxicity, defibrillation is indicated at low energy levels or is not performed because of the risk of causing further arrhythmias for the patient. Elective cardioversion is contraindicated when there are thrombi (blood clots) in the heart chambers.

Defibrillation is an important life-saving method in medicine, capable of restoring a normal heart rhythm and improving the patient's condition in emergency situations. Understanding the indications and contraindications will help improve the ability to save patients. Hopefully, this article provides useful information and helps you better understand the indications for defibrillation. Share to raise community awareness about saving patients in emergency situations!

Article uses reference materials from the document: Guidelines on Internal Medicine Technical Procedures, Cardiology specialty of the Ministry of Health (2014), Medical Publishing House, Hanoi.