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November 1, 1976


Author Affiliations

University of Arizona College of Medicine Tucson
Medical University of South Carolina Charleston

JAMA. 1976;236(18):2053. doi:10.1001/jama.1976.03270190015013

To the Editor.—  In reference to the letters submitted by Tacker et al (235:144, 1976) and Crampton et al (235:2284, 1976), resolution of the apparent conflict may lie in consideration of variables other than body weight that influence ventricular defibrillation. References can be found in the literature to such factors as frequency of countershock, paddle size, electrical waveform, and duration of fibrillation. Twenty years ago, Kouwenhoven and Milnor1 concluded that the chances for closed-chest defibrillation and spontaneous return of a "normal heart action" were time-dopendent and decreased significantly after one minute of ventricular fibrillation. This was observed despite the use of dc capacitor energies far in excess of those recommended by Geddes et al.2 In the clinical studies of Tacker et al3 and Pantridge et al,4 duration of fibrillation is imprecisely defined, varying respectively from "5 minutes or less" to "2 minutes or less." It is