Effect of higher currents on defibrillation success in out-of-hospital cardiac arrest: a multicentre cohort analysis

Successful defibrillation requires sufficient electrical current to depolarize a critical mass of myocardial cells. The corpuls3 is available with the MAX option (MAX), which delivers its technically highest possible current for the actual impedance, instead of a fixed energy. This retrospective analysis compared shock success with MAX versus the standard 200 J setting. We retrospectively analysed ECG records from out-of-hospital cardiac arrests (OHCAs) in four German regions (May 2022–June 2024) to compare termination of fibrillation (TOF) and return of organised rhythm (ROOR) after shocks with MAX or 200 J. A total of 1457 shocks with MAX and 2348 shocks with 200 J were included. First-shock success did not differ significantly between MAX and 200 J (TOF: 81 % vs. 76 %, p = 0.11; ROOR: 66 % vs. 64 %, p = 0.66). Considering all shocks, MAX achieved higher success rates (TOF: 80 % vs. 72 %, p < 0.001; ROOR: 67 % vs. 63 %, p = 0.02). When limiting the analysis to the first three shocks, patients treated exclusively with MAX achieved first TOF after 1.17 ± 0.44 shocks, compared to 1.36 ± 0.91 shocks for those receiving only 200 J ( p = 0.02). Within three shocks, TOF was reached in 93.1 % of patients receiving only MAX versus 89.3 % receiving only 200 J ( p = 0.05). MAX does not improve first-shock success compared to 200 J, but overall TOF and ROOR rates are significantly higher with MAX.