In the case of a witnessed and monitored VF/pVT cardiac arrest, how should the defibrillator be used?

In the scenario of a witnessed and monitored ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) cardiac arrest, the use of a defibrillator is critical for effective resuscitation. The recommended approach is to deliver up to three quick successive shocks when the event is witnessed and confirmed, as the chances of restoring a viable heart rhythm are highest immediately after the onset of the cardiac arrest.

This approach is based on the understanding that VF and pVT are shockable rhythms, and immediate defibrillation can help reset the heart’s electrical activity, potentially allowing for successful return of circulation. The rationale for delivering quick successive shocks is to reduce the time spent in VF or pVT, thereby minimizing cellular damage that occurs with prolonged ischemia.

Delivering more than one shock promptly can increase the likelihood of converting the arrhythmia to a perfusing rhythm, particularly in the first few minutes following a collapse when the heart is still potentially salvageable. Following the initial shocks, high-quality CPR should commence, ensuring that oxygenated blood is circulated to vital organs until further assessments and interventions can be made.

In contrast, other approaches, such as administering just one shock followed by immediate CPR, may delay the critical need for multiple shocks