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(Circulation. 2005;112:IV-35 – IV-46.)
© 2005 American Heart Association, Inc.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Part 5: Electrical Therapies

Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing

	Introduction

 
This chapter presents guidelines for defibrillation with automated external defibrillators (AEDs) and manual defibrillators, synchronized cardioversion, and pacing. AEDs may be used by lay rescuers and healthcare providers as part of basic life support. Manual defibrillation, cardioversion, and pacing are advanced life support therapies.

	Defibrillation Plus CPR: A Critical Combination

 
Early defibrillation is critical to survival from sudden cardiac arrest (SCA) for several reasons: (1) the most frequent initial rhythm in witnessed SCA is ventricular fibrillation (VF), (2) the treatment for VF is electrical defibrillation, (3) the probability of successful defibrillation diminishes rapidly over time, and (4) VF tends to deteriorate to asystole within a few minutes.¹

Several studies have documented the effects of time to defibrillation and the effects of bystander CPR on survival from SCA. For every minute that passes between collapse and defibrillation, survival rates from witnessed VF SCA decrease 7% to 10% if no CPR is provided.¹ When bystander CPR is provided, the decrease in survival rates is more gradual and averages 3% to 4% per minute from collapse to defibrillation.^1,2 CPR can double^1–3 or triple⁴ survival from witnessed SCA at most intervals to defibrillation.

If bystanders provide immediate CPR, many adults in VF can survive with intact neurologic function, especially if defibrillation is performed within about 5 minutes after SCA.^5,6 CPR prolongs VF^7–9 (ie, the window of time during which defibrillation can occur) and provides a small amount of blood flow that may maintain some oxygen and substrate delivery to the heart and brain.¹⁰ Basic CPR alone, however, is unlikely to . . . [Full Text of this Article]