In ventricular fibrillation (VF) cardiac arrest, the recommended energy for the THIRD defibrillation attempt using a biphasic defibrillator as per current guidelines is:
- A 200 J for all subsequent shocks
- B 360 J (maximum monophasic equivalent)
- C Escalating dose up to 360 J equivalent biphasic for third and subsequent shocks ✓
- D 150–200 J for second shock; manufacturer's recommended dose for subsequent
Explanation
AHA 2020 and ERC 2021 guidelines recommend: first biphasic shock at 120–200 J (device-specific), second shock at same or higher energy, and third and subsequent shocks at the maximum energy the device allows (approximately 200–360 J for biphasic devices, as equivalent to 360 J monophasic). Current guidance allows escalating energy for refractory VF. Fixed-dose 200 J protocols are device-specific and acceptable if evidence-based. The key principle is that shocks should be followed by immediate resumption of CPR without rhythm check; shocks should not be interrupted by prolonged pauses.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.