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Monophasic versus biphasic defibrillation for pediatric out-of-hospital cardiac arrest patients: a nationwide population-based study in Japan

Seizan Tanabe1*, Hideo Yasunaga2, Soichi Koike3, Manabu Akahane4, Toshio Ogawa4, Hiromasa Horiguchi2, Tetsuo Hatanaka5, Hiroyuki Yokota1 and Tomoaki Imamura4

Author Affiliations

1 Department of Emergency & Critical Care Medicine, Nippon Medical School 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan

2 Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan

3 Department of Planning, Information and Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan

4 Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan

5 Foundation for Ambulance Service Development, Emergency Life-Saving Technique Academy of Kyushu, 3-8-1 Ohura, Yahatanishi-ku, Kitakyushu, Fukuoka 807-0874, Japan

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Critical Care 2012, 16:R219  doi:10.1186/cc11864

Published: 13 November 2012



Conventional monophasic defibrillators for out-of-hospital cardiac-arrest patients have been replaced with biphasic defibrillators. However, the advantage of biphasic over monophasic defibrillation for pediatric out-of-hospital cardiac-arrest patients remains unknown. This study aimed to compare the survival outcomes of pediatric out-of-hospital cardiac-arrest patients who underwent monophasic defibrillation with those who underwent biphasic defibrillation.


This prospective, nationwide, population-based observational study included pediatric out-of-hospital cardiac-arrest patients from January 1, 2005, to December 31, 2009. The primary outcome measure was survival at 1 month with minimal neurologic impairment. The secondary outcome measures were survival at 1 month and the return of spontaneous circulation before hospital arrival. Multivariable logistic regression analysis was performed to identify the independent association between defibrillator type (monophasic or biphasic) and outcomes.


Among 5,628 pediatric out-of-hospital cardiac-arrest patients (1 through 17 years old), 430 who received defibrillation shock with monophasic or biphasic defibrillator were analyzed. The number of patients who received defibrillation shock with monophasic defibrillator was 127 (30%), and 303 (70%) received defibrillation shock with biphasic defibrillator. The survival rates at 1 month with minimal neurologic impairment were 17.5% and 24.4%, the survival rates at 1 month were 32.3% and 35.6%, and the rates of return of spontaneous circulation before hospital arrival were 24.4% and 27.4% in the monophasic and biphasic defibrillator groups, respectively. Hierarchic logistic regression analyses by using generalized estimation equations found no significant difference between the two groups in terms of 1-month survival with minimal neurologic impairment (odds ratio (OR), 1.57; 95% confidence interval (CI), 0.87 to 2.83; P = 0.14) and 1-month survival (OR, 1.38; 95% CI, 0.87 to 2.18; P = 0.17).


The present nationwide population-based observational study could not confirm an advantage of biphasic over monophasic defibrillators for pediatric OHCA patients.