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(Circulation. 2006;114:2001.)
© 2006 American Heart Association, Inc.

Issue Highlights

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	TRANSTHORACIC INCREMENTAL MONOPHASIC VERSUS BIPHASIC DEFIBRILLATION BY EMERGENCY RESPONDERS (TIMBER): A RANDOMIZED COMPARISON OF MONOPHASIC WITH BIPHASIC WAVEFORM ASCENDING ENERGY DEFIBRILLATION FOR THE RESUSCITATION OF OUT-OF-HOSPITAL CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION, by Kudenchuk et al.

 
Shocks with a biphasic wave form are more effective than monophonic shocks for terminating ventricular fibrillation in many situations. All new defibrillators have biphasic waveforms, but a large number of monophasic waveform devices remain in use. Should replacement of these devices receive a high priority? Kudenchuk and colleagues conducted a randomized trial comparing monophasic and biphasic shocks for treatment of out-of-hospital cardiac arrests. A unique aspect of their trial was blinding of the investigators that extended through the data analysis and review process, unblinding only after the manuscript had been accepted for publication. Arrest victims received cardiopulmonary resuscitation before shock, consistent with present guidelines. Biphasic waveform defibrillation was not superior to the monophasic waveform, although a trend toward better survival did favor the biphasic waveform. The study should inform communities and institutions that are prioritizing resources for replacement of monophasic waveform defibrillators. See p 2010.

	HOSPITAL DELAYS IN REPERFUSION FOR ST-ELEVATION MYOCARDIAL INFARCTION: IMPLICATIONS WHEN SELECTING A REPERFUSION STRATEGY, by Pinto et al.

 
The survival benefit associated with primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction may be attenuated if door-to-balloon (DB) time is delayed by 1 hour beyond door-to-needle (DN) times for fibrinolytic therapy. Whereas DB times are rapid in randomized trials, they are often prolonged in routine practice. In this issue of Circulation, Pinto et al calculated DB-DN times by subtracting median DN time from median DB time at a hospital using data from 192 509 patients at 645 National Registry of Myocardial Infarction hospitals. Longer DB-DN times were associated with increased mortality. The DB-DN times in which mortality rates with PPCI . . . [Full Text of this Article]

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