Defibrillation in the Cardiac Arrest Patient

Emerg Med Clin North Am. 2023 Aug;41(3):529-542. doi: 10.1016/j.emc.2023.03.006. Epub 2023 Apr 10.


Defibrillation is one of the few interventions known to favorably impact survival in cardiac arrest. In witnessed arrest, survival improves with defibrillation as early as possible, whereas it may improve outcomes to administer high-quality chest compressions for 90 seconds before defibrillation in unwitnessed arrest. Minimizing pre-, peri-, and post-shock pauses has been shown to have mortality benefits. Refractory ventricular fibrillation has high mortality rates, and there is ongoing research into promising adjunctive treatment modalities. There remains no consensus on optimal pad positioning and defibrillation energy level, however, recent data suggest anteroposterior pad placement may be superior to anterolateral placement.

Keywords: Cardiac arrest; Defibrillation; Efficacy of defibrillation; Refractory arrhythmia.

Publication types

  • Review

MeSH terms

  • Electric Countershock*
  • Heart Arrest* / therapy
  • Humans