Opening of Bids - Eight Cardiac Monitors Defibrillators - Physio-Control, Inc. - Part 2

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Clinical Overview Biphasic clefibrilllation comparison These data represent the cumulative number of cardiac arrest patients in whom the VF termination efficacy (using the established definition of"re oval of VF for _> 5 seconds") of specific biphasic waveforms and energy levels has been reported in published papers describing either randomized or consecutive case series of oHHCA or IIICA patients. Included are papers that report a VF termination rate for at least one of 11 first shocks or Z) all shocks. Based on information available in the published literature as of March 201.8. **May deliver more energy than the E Series, M Series and ZOLL AEDs.zi,ee'rhis is less than the maximum energy delivered in LIFEPAK monitor/defibrillators and LIFE PAK AEDs. Clinical strategies to improve conversion rates The Critical Mass Theory is a meaningful conceptualization that can help clinicians improve conversion rates.' The goal is to depolarize as much of the myocardial tissue as possible at once, placing it into a repolarized, refractory state unable to re -propagate the electrical misfires that cause Vk/pVT. Two controllable factors can significantly impact this complex biological interaction. 1. optimize the size of the defibrillation field Higher energy (J) can increase a shock's myocardial coverage while less energy likely covers less. Data supports escalating to 3601 as a mechanism to maximize conversion rates.'.4,'a Suboptimal energy dose Myocardium not exposed to sufficient electrical field Closing point's • Science recognizes that no individual characteristic of a well - designed biphasic waveform determines conversion rate. The combined total of a shock's electrical characteristics (energy expressed in joules), determines conversion rate. • The data shows that at the same low energy biphasic shocks, the most widely used defibrillation waveforms (BTE and RBW) have the same conversion rates from 50J to 240J. 2. Optimize the vector of the defibrillation field Suboptimal pad placements can also lower conversion rates. Escalating to 360J can compensate for these variations." Suboptimal pad placement, Myocardium not exposed to sufficient electrical field i�—. I Optimal lateral Published clinical data demonstrate protocols with escalating energy to 360J improves conversion rates for difficult -to -defibrillate VF and AF patients, No commercially available defibrillator on the market offers equivalent strength to full energy biphasic (360J) offered by Physio-Control LIFEPAX defibrillators for both AED and manual defibrillation.