See critical care quick reference for defibrillation settings (joules) by weight.
It is important to note that the procedure for and indications differ between defibrillation and cardioversion
Defibrillation (Unsynchronized cardioversion)
- Supraventricular tachycardia (SVT)
- Atrial fibrillation
- Atrial flutter
- Ventricular tachycardia with a pulse
- Automated External Defibrillator (AED)
- Apply pads or paddles
- Paddles may be slightly quicker but pads are viewed to be safer
- Larger pads reduce transthoracic impedance
- “Adult” size in adults
- “Adult” size (8 to 10 cm) for children >10 kg (> approximately 1 year)
- “Infant” size for infants <10 kg
- 4 accepted pad positions: anterolateral, anteroposterior, anterior-left infrascapular, and anterior-right-infrascapular
- Anteroposterior position performs slightly better
- Biphasic setting
- Defibrillator Refractory VF
- Benedikte H, et al. Time and safety in defibrillation with paddles versus pads: A comparative study of two defibrillation regimes. Resuscitation. 2013; 84(11):e141–e142.
- Connell PN, et al. Transthoracic impedance to defibrillator discharge. Effect of electrode size and electrode-chest wall interface. J Electrocardiol. 1973; 6:313–M.
- Atkins DL, et al. Pediatric defibrillation: current flow is improved by using “adult” electrode paddles. Pediatrics. 1994; 94:90–93.
- Krasteva V, et al. Transthoracic impedance study with large self-adhesive electrodes in two conventional positions for defibrillation. Physiol Meas. 2006; 27:1009–1022.
- Neumar RW, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Part 8: Adult Advanced Cardiovascular Life Support. Circulation. 2010; 122: S729-S767.
- Kleinman ME, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Part 14: Pediatric Advanced Life Support. Circulation. 2010; 122: S876-S908.
- Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.
- Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.