Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

16 November 2020 : Case report  USA

External Cardioversion-Defibrillation with Pushing Down on the Chest Wall to Increase the Success Rate in Obese Patients

Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)

Ming-Lon Young1ABCDEF*, Eric J. Exelbert2B, Todd Roth3B, Lance Cohen4B, John Cogan3BE

DOI: 10.12659/AJCR.927009

Am J Case Rep 2020; 21:e927009

Abstract

BACKGROUND: The energy delivered by a defibrillator is expressed in joules (J). However, current is what actually defibrillates the heart and is related to the voltage-to-impedance ratio. With the same energy, the lower the transthoracic impedance, the higher the current delivered. In obese patients, pushing the chest wall toward the heart during electric shock can result in an improved outcome.

CASE REPORT: We report the cases of 3 obese patients with previously failed cardioversion/defibrillation who had an eventual shock success. (1) A 17-year-old girl failed multiple defibrillation efforts for her recurrent ventricular fibrillation. After ECMO, with the physician pushing down the chest wall, a 200-J defibrillation converted her VF. (2) A 63-year-old man with recurrent atrial fibrillation (AF) had an unsuccessful 150-J shock followed by a successful 200-J cardioversion. His AF recurred. After amiodarone bolus, a 200-J shock converted it to sinus. Another recurrent AF failed 150-J cardioversion. With chest pushing down, a 150-J cardioversion was successful. (3) A 65-year-old man underwent elective cardioversion for AF. A 200-J shock was unsuccessful. A 200-J shock with pressure on the chest successfully converted it.

CONCLUSIONS: We performed successful electrical cardioversion/defibrillation with this “pushing down the chest while shocking” method. Many clinicians are still unaware of this method, especially in obese patients. With the increasing prevalence of obesity, it is urgent to perform a randomized study to confirm the efficacy and safety of this method, and integrate it into advanced cardiac life support protocols.

Keywords: Atrial Fibrillation, Electric Countershock, Ventricular Fibrillation

0 Comments

SARS-CoV-2/COVID-19

26 November 2021 : Editorial  USA

Editorial: SARS-CoV-2 Vaccine Responses and Breakthrough COVID-19

Med Sci Monit In Press; DOI: 10.12659/MSM.935624  

26 November 2021 : Case report  Poland

Arteritic Anterior Ischemic Optic Neuropathy in the Course of Giant Cell Arteritis After COVID-19

Am J Case Rep In Press; DOI: 10.12659/AJCR.933471  

26 October 2021 : Case report  USA

Progressive Pulmonary Fibrosis After Non-Critical COVID-19: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.933458  

25 November 2021 : Case report  USA

A Case of COVID-19-Associated Free-Floating Aortic Thrombus Successfully Treated with Thrombectomy

Am J Case Rep 2021; 22:e933225

In Press

26 Nov 2021 : Case report  Japan

A Case of Metaplastic Squamous Cell Carcinoma of the Breast that Showed a Pathological Complete Response Af...

Am J Case Rep In Press; DOI: 10.12659/AJCR.935035  

26 Nov 2021 : Case report  Poland

Arteritic Anterior Ischemic Optic Neuropathy in the Course of Giant Cell Arteritis After COVID-19

Am J Case Rep In Press; DOI: 10.12659/AJCR.933471  

25 Nov 2021 : Case report  Kuwait

A Well-Differentiated Grade-3 Neuroendocrine Tumor in the Ascending Colon: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.933792  

25 Nov 2021 : Case report  USA

Clinically Isolated Brainstem Progressive Multifocal Leukoencephalopathy: Diagnostic Challenges

Am J Case Rep In Press; DOI: 10.12659/AJCR.935019  

Most Viewed Current Articles

15 Aug 2020 : Case report  USA

A 57-Year-Old African American Man with Severe COVID-19 Pneumonia Who Responded to Supportive Photobiomodul...

DOI :10.12659/AJCR.926779

Am J Case Rep 2020; 21:e926779

09 May 2019 : Case report  USA

A Rare Case of Stage IV Basaloid Squamous Cell Cancer with Intrapulmonary and Brain Metastases

DOI :10.12659/AJCR.915073

Am J Case Rep 2019; 20:664-667

13 Mar 2019 : Case report  USA

Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke’s Encephalopathy...

DOI :10.12659/AJCR.914051

Am J Case Rep 2019; 20:330-334

09 Jan 2019 : Case report  Saudi Arabia

3-M Syndrome: A Local Case Report

DOI :10.12659/AJCR.912736

Am J Case Rep 2019; 20:36-38

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923