Biphasic should replace Monophasic Defibrillators

Though I have not claimed to be an expert, I will assert that my education on the subject is superior to that of my opponent- however, that is not the basis of any of my arguments. I will point some things out in my opponent's first posted study (please refer to the link in his R1 argument)- From the Cardiac Rhythm Management Laboratory, Division of Cardiovascular Diseases, Department of Medicine, Department of Physiology, and Department of Biomedical Engineering, University of Alabama at Birmingham (J.H., D.L.R., W.M.S., R.E.I.), Birmingham, Ala, and Guidant Corporation (B.H.K.), Cardiac Rhythm Management Group, St Paul, Minn. I have posted this information simply to point out the similarities in the expertise of those listed in the study and my own. I am the Lead Biomedical Technician at St. Joseph's Hospital's Biomedical Engineering Department. I am pointing this out due to the technical level my opponent has forced me to respond in. I will put quotes from his studies in quotes, and follow up with how I have addressed these statements in my arguments, and how my opponent has ignored the expertise of his own sources. "300-ï¿½F-capacitor defibrillator"/"140-ï¿½F-capacitor defibrillator"- Method of delivery of shocks cited in my opponent's source. Note the names of the departments above. "Under fluoroscopic guidance, via right external jugular access"- Fluoroscopy is a process of real time x-ray through a fluoroscopic image intensifier. It is used during invasive surgeries. The right external jugular is a vein. My opponent cites this as evidence that the ICD's are external defibrillators, but it is evident that the electrodes in question in this paragraph are internal. The superior vena cava is another vein. The "rv apex"? Right ventricular- the right ventricle is a part of the heart. This is why if we cite a source we must understand the information contained therein. The 0094 Endotak Lead is a subcutaneous electrode. "Jian Huang, MD; Bruce H. KenKnight, PhD; Dennis L. Rollins, MS; William M. Smith, PhD; Raymond E. Ideker, MD, PhD"- These are the names of the doctors conducting the study. http://www.freepatentsonline.com... This is a link to their filing of a patent for the ICD's developed during the study, and explanation of their purpose and findings, and the explanation of their use of the VENTAK™ external cardioverter defibrillator. The term "external cardioverter" in reference to an ICD refers to the position of the leads external to the veins rather than internal to them, not the defibrillator itself. http://74.125.95.132/search?q=cache:57uqV6EerAIJ:bulk.resource.org/gpo.gov/register/1995/1995_19948.pdf+VENTAK%E2%84%A2+external+cardioverter+defibrillator&hl=en&ct=clnk&cd=3&gl=us Now, to emphasize the study addresses ICD's there is this statement "This study only tested 300-ï¿½F-capacitor triphasic waveforms; it is unknown whether the findings would also apply to triphasic waveforms delivered from other-size capacitors." My opponent bases his entire case on the following statement: "However, most defibrillators that can deliver a biphasic waveform already contain the switches and other hardware necessary for delivery of a triphasic waveform. Therefore, slight alteration of the software in the defibrillator to switch the waveform a second time to deliver the third phase is the main change required for delivery of a triphasic shock." This is obviously in reference to ICD's using 300 micro farad capacitors, and no other types of defibrillators because they were not tested. Now, on to the other study... It is important to note that this study was exclusive to pigs. Here is the first statement I will address. "Defibrillating shocks were delivered from a custom-built defibrillator with a 115-ï¿½F capacitor, which was capable of delivering biphasic or triphasic truncated exponential waveform shocks with polarity, pulse duration, and selected energy, as determined by the operator"- A custom built defibrillator does not possess various protections for the patient that a commercially available defibrillator would provide. A custom built defibrillator tested on pigs also cannot be looked to as an option for replacing commercially tested and approved Class II defibrillators. "The defibrillation shocks were delivered from commercially available self-adhesive monitor-defibrillator electrode pads"- This second study did in fact employ external defibrillation, HOWEVER this study does not claim that biphasic defibrillators can be easily converted into triphasic defibrillators, and in fact does not use a commercially available biphasic defibrillator altered to deliver triphasic shocks, rather it used a custom built defibrillator. This, besides my last contention, nullifies this line of argument from my opponent. My opponent states that both of his studies "used external defibrillation". His claim that I have fabricated facts to the contrary has been proven false, and his argument is nullified. My opponent cannot show how an external biphasic defibrillator can be converted into a triphasic defibrillator. "The electrode pads we used are proportionately large for 18- to 28-kg pigs compared with 70-kg humans...These species differences may explain the observation that the highest biphasic waveform success rate we observed was about 80%, whereas in humans, higher success rates have been observed"- I posted a link to a study in which higher success rates of defibrillation were observed amongst human patients using biphasic defibrillators. My opponent's own study suggests it could not reproduce this feat due to their limitations using pigs, and therefore the results of the study cannot be applied to humans, as there is no telling what the comparison would be between triphasic vs. biphasic amongst humans. "The waveforms utilized in our custom-made defibrillator did not compensate for high impedance by automatically adjusting the duration and/or voltage of the pulses, as do some commercially available biphasic waveform defibrillators."- Another failure in this study, and more evidence that the defibrillators used in these studies are not compatible with commercially available biphasic defibrillators. As for my opponent's contentions against commercial availability, it is obvious I meant to say "commercially available TO hospitals" as I made the statement "commercially available", excluding the "in hospitals" designation several times throughout my arguments. As for his statement on immediate availability, my opening statement makes it obvious that my premise is based on commercially available technologies. My premise refers to "biphasic defibrillators", and their efficiency compared to monophasic defibrillators, while my opponent's contention is based on waveforms- not commercially available defibrillators. Read from my R1- "My position is that biphasic defibrillators are more beneficial to the patient, are more efficient, and provide more reliable technology than do monophasic defibrillators." An obvious Con to this statement would be "biphasic defibrillators are not more beneficial to the patient, more efficient, and a more reliable technology than monophasic defibrillators". My opponent's alternative of triphasic defibrillators cannot make the claim "triphasic defibrillators are more beneficial to the patient, more efficient, and provide more reliable technology than biphasics" because triphasic defibrillators are not commercially available, and are not a technology that has been developed. My argument is not that triphasics should not be developed, but if it takes ten years before they are commercially available I will argue (if proven more efficient) that they should replace the outdated biphasics. It is important to note that the average life cycle of medical equipment is ten years, and if they are available in such time this position would THEN be consistent with traditional replacement policies. Thank you.