Acute Care 18: Electrical Cardioversion Algorithm—
Adult and Pediatric
Synchronized cardioversion is used to treat patients with supraventricular tachycardia (SVT) or ventricular tachycardia (VT) who have a pulse and are symptomatic with poor perfusion, hypotension, or heart failure.
If the patient is unstable and rhythm is not sinus tachycardia, junctional tachycardia, or multifocal atrial tachycardia, prepare for immediate cardioversion. May give brief trial of medications based on specific arrhythmias. Immediate cardioversion is generally not needed for rates < 150 bpm.
Team Actions to Prepare for Planned Electrical Cardioversion
|
Premedicate whenever
possible.
Use sedatives with or without analgesic agents.
Sedation must not delay cardioversion in emergency situations.
| Sedative Choices | Analgesic Choices |
| Etomidate 0.1 to 0.3 mg/kg IV | Fentanyl 1 to 5 μg/kg IV |
| Adult: Midazolam (Versed) 0.02 to 0.1 mg/kg IV Pediatric: Midzolam (Versed) 0.05 to 0.15 mg/kg IV |
Morphine 0.05 to 0.15 mg/kg IV |
| Adult: Propofol 1 to
2 mg/kg IV Pediatric: Propofol 1 to 2.5 mg/kg IV |
| Defibrillator Energy Delivery for Adult Cardioversion1 | ||
| Synchronized | ||
| Rhythm | Monophasic
Defibrillator |
Biphasic Defibrillator |
| Atrial
fibrillation (narrow complex, irregular) |
200 J | 120 J to 200 J |
| Atrial flutter | 50 J to 100 J | NA* |
| PSVT
(narrow Complex, regular) |
50 J to 100 J | NA* |
| VT-monomorphic (wide complex, regular) |
100 J to 360 J | NA* |
| Unsynchronized | ||
| VT-polymorphic (wide complex, irregular) |
360 J (unsynchronized) | Device
specific (or 200 J) (unsynchronized) |
| *NA= insufficient data to recommend energy levels; use the same as or less than monophasic | ||
Synchronized
Cardioversion for Pediatric Patients
|
References
- Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S706 –S719.