Why doesn’t the HeartStart OnSite deliver escalating high energy?
Escalating energy implies that you deliver your first shock with low energy, holding back potency, and only resort to higher potency if the early defibrillation attempts fail. The only reason to hold back potency on early defibrillation attempts would be to avoid the possibility of the side effect of cardiac dysfunction at a time when the heart is most fragile. In fact, there is a downside to high-energy shocks. While high peak current is associated with defibrillation effectiveness, high energy can result in a delay in the return of spontaneous circulation (ROSC) due to cardiac dysfunction caused by stunning.1 Philips delivers a high peak-current waveform using a low-energy shock. So with Philips SMART Biphasic therapy, the patient receives our most potent therapy with the very first shock and on every subsequent shock. There is no need to escalate when every shock is already at maximum effectiveness. Guidelines 2005 has taken the clear position that there is no demonstrable advantage
