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Pandit SV, Lampe JW, Silver AE. Recurrence of ventricular fibrillation in out-of-hospital cardiac arrest: Clinical evidence and underlying ionic mechanisms. J Physiol 2024. [PMID: 38661672 DOI: 10.1113/jp284621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/08/2024] [Indexed: 04/26/2024] Open
Abstract
Defibrillation remains the optimal therapy for terminating ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients, with reported shock success rates of ∼90%. A key persistent challenge, however, is the high rate of VF recurrence (∼50-80%) seen during post-shock cardiopulmonary resuscitation (CPR). Studies have shown that the incidence and time spent in recurrent VF are negatively associated with neurologically-intact survival. Recurrent VF also results in the administration of extra shocks at escalating energy levels, which can cause cardiac dysfunction. Unfortunately, the mechanisms underlying recurrent VF remain poorly understood. In particular, the role of chest-compressions (CC) administered during CPR in mediating recurrent VF remains controversial. In this review, we first summarize the available clinical evidence for refibrillation occurring during CPR in OHCA patients, including the postulated contribution of CC and non-CC related pathways. Next, we examine experimental studies highlighting how CC can re-induce VF via direct mechano-electric feedback. We postulate the ionic mechanisms involved by comparison with similar phenomena seen in commotio cordis. Subsequently, the hypothesized contribution of partial cardiac reperfusion (either as a result of CC or CC independent organized rhythm) in re-initiating VF in a globally ischaemic heart is examined. An overview of the proposed ionic mechanisms contributing to VF recurrence in OHCA during CPR from a cellular level to the whole heart is outlined. Possible therapeutic implications of the proposed mechanistic theories for VF recurrence in OHCA are briefly discussed.
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Affiliation(s)
- Sandeep V Pandit
- University of Memphis, ZOLL Medical, Chelmsford, Massachusetts, USA
| | - Joshua W Lampe
- University of Pennsylvania, ZOLL Medical, Chelmsford, Massachusetts, USA
| | - Annemarie E Silver
- University of Colorado Boulder, ZOLL Medical, Chelmsford, Massachusetts, USA
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Jung YH, Jeung KW, Lee HY, Lee BK, Lee DH, Shin J, Lee HJ, Cho IS, Kim YM. Rearrest during hospitalisation in adult comatose out-of-hospital cardiac arrest patients: Risk factors and prognostic impact, and predictors of favourable long-term outcomes. Resuscitation 2021; 170:150-159. [PMID: 34871759 DOI: 10.1016/j.resuscitation.2021.11.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/04/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rearrest occurs commonly after initial resuscitation following out-of-hospital cardiac arrest (OHCA). We determined (1) the predictors of rearrest during hospitalisation that can be identified in the hours immediately after OHCA, (2) the association between rearrest and favourable long-term outcomes, and (3) the predictors of favourable long-term outcomes in rearrest patients. METHODS Conditional multivariable logistic regression analyses were performed using the Korean Hypothermia Network prospective registry data, which included details of adult OHCA patients treated with targeted temperature management at 22 teaching hospitals in South Korea. RESULTS Among the 1,233 patients, 260 (21.1%) experienced rearrest. Of the 192 patients resuscitated from first rearrest, 33 (17.2%) achieved 6-month favourable outcomes. Arrhythmia, heart failure, ST-segment elevation, lower initial Glasgow coma scale (GCS) motor score, higher initial lactate level, and antiarrhythmic drug use within 1 h were independently associated with rearrest. Higher lactate level and antiarrhythmic drug use were associated with shockable first rearrest, while arrhythmia, heart failure, ST-segment elevation, and lower GCS motor score were associated with non-shockable first rearrest. Rearrest was independently associated with a lower likelihood of 6-month favourable outcomes (P = 0.003). Initial shockable rhythm after OHCA, absence of diabetes, shorter cumulative time to restoration of spontaneous circulation, coronary angiography, and hypophosphataemia within 7 d were independently associated with 6-month favourable outcomes in the patients resuscitated from first rearrest. CONCLUSIONS Rearrest during hospitalisation after OHCA was inversely associated with 6-month favourable outcomes. We identified several risk factors for rearrest and prognostic factors for patients resuscitated from first rearrest.
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Affiliation(s)
- Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Republic of Korea; Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Republic of Korea; Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, Republic of Korea.
| | - Hyoung Youn Lee
- Trauma Centre, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Republic of Korea; Department of Emergency Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju, Republic of Korea
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Republic of Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Republic of Korea
| | - In Soo Cho
- Department of Emergency Medicine, Hanil General Hospital, 308 Uicheon-ro, Dobong-gu, Seoul, Republic of Korea
| | - Young-Min Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul, Republic of Korea
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Optimization of End-to-End Convolutional Neural Networks for Analysis of Out-of-Hospital Cardiac Arrest Rhythms during Cardiopulmonary Resuscitation. SENSORS 2021; 21:s21124105. [PMID: 34203701 PMCID: PMC8232133 DOI: 10.3390/s21124105] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
High performance of the shock advisory analysis of the electrocardiogram (ECG) during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) is important for better management of the resuscitation protocol. It should provide fewer interruptions of chest compressions (CC) for non-shockable organized rhythms (OR) and Asystole, or prompt CC stopping for early treatment of shockable ventricular fibrillation (VF). Major disturbing factors are strong CC artifacts corrupting raw ECG, which we aimed to analyze with optimized end-to-end convolutional neural network (CNN) without pre-filtering or additional sensors. The hyperparameter random search of 1500 CNN models with 2-7 convolutional layers, 5-50 filters and 5-100 kernel sizes was done on large databases from independent OHCA interventions for training (3001 samples) and validation (2528 samples). The best model, named CNN3-CC-ECG network with three convolutional layers (filters@kernels: 5@5,25@20,50@20) presented Sensitivity Se(VF) = 89%(268/301), Specificity Sp(OR) = 91.7%(1504/1640), Sp(Asystole) = 91.1%(3325/3650) on an independent test OHCA database. CNN3-CC-ECG's ability to effectively extract features from raw ECG signals during CPR was comprehensively demonstrated, and the dependency on the CPR corruption level in ECG was tested. We denoted a significant drop of Se(VF) = 74.2% and Sp(OR) = 84.6% in very strong CPR artifacts with a signal-to-noise ratio of SNR < -9 dB, p < 0.05. Otherwise, for strong, moderate and weak CC artifacts (SNR > -9 dB, -6 dB, -3 dB), we observed insignificant performance differences: Se(VF) = 92.5-96.3%, Sp(OR) = 93.4-95.5%, Sp(Asystole) = 92.6-94.0%, p > 0.05. Performance stability with respect to CC rate was validated. Generalizable application of the optimized computationally efficient CNN model was justified by an independent OHCA database, which to our knowledge is the largest test dataset with real-life cardiac arrest rhythms during CPR.
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Aschieri D, Guerra F, Pelizzoni V, Paolini E, Stronati G, Moderato L, Losi G, Compagnucci P, Coccia M, Casella M, Dello Russo A, Bardy GH, Capucci A. Ventricular Fibrillation Recurrences in Successfully Shocked Out-of-Hospital Cardiac Arrests. ACTA ACUST UNITED AC 2021; 57:medicina57040358. [PMID: 33917184 PMCID: PMC8067796 DOI: 10.3390/medicina57040358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: The prognostic impact of ventricular fibrillation (VF) recurrences after a successful shock in out-of-hospital cardiac arrest (OOHCA) is still poorly understood, and some evidence suggests a potential pro-arrhythmic effect of chest compressions in this setting. In the present analysis, we looked at the short-term and long-term prognosis of VF recurrences in OOHCA. And their potential association with chest compressions. Materials and Methods: The Progetto Vita, prospectively collecting data on all resuscitation efforts in the Piacenza province (Italy), was used for the present analysis. From the 461 OOHCAs found in a shockable rhythm, only those with optimal ECG tracings and good audio recordings (160) were assessed. Rhythms other than VF post-shock were analyzed five seconds after shock delivery and survival to hospital admission, hospital discharge, and long-term survival data over a 14-year follow-up were collected. Results: Population mean age was 64.4 ± 16.9 years, and 31.9% of all patients were female. Mean time to EMS arrival was 5.9 ± 4.5 min. Short- and long-term survival without neurological impairment were higher in patients without VF recurrence when compared to patients with VF recurrence, independently from the pre-induction rhythm (p < 0.001). After shock delivery, VF recurrence was higher when chest compressions were resumed early after discharge and more vigorously. Conclusions: VF recurrences after a shock could worsen short and long-term survival. The potential pro-arrhythmic effect of chest compressions should be factored in when considering the real risks and benefits of this procedure.
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Affiliation(s)
- Daniela Aschieri
- Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; (D.A.); (G.L.); (M.C.)
| | - Federico Guerra
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
- Correspondence:
| | - Valentina Pelizzoni
- Cardiology Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy; (V.P.); (L.M.)
| | - Enrico Paolini
- Cardiology Department, “Ospedali Riuniti Marche Nord”, 61121 Pesaro, Italy;
| | - Giulia Stronati
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
| | - Luca Moderato
- Cardiology Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy; (V.P.); (L.M.)
| | - Giulia Losi
- Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; (D.A.); (G.L.); (M.C.)
| | - Paolo Compagnucci
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
| | - Michela Coccia
- Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; (D.A.); (G.L.); (M.C.)
| | - Michela Casella
- Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Antonio Dello Russo
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
| | - Gust H. Bardy
- Seattle Institute for Cardiac Research, Seattle, WA 98195, USA;
| | - Alessandro Capucci
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
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Didon JP, Ménétré S, Jekova I, Stoyanov T, Krasteva V. Analyze Whilst Compressing algorithm for detection of ventricular fibrillation during CPR: A comparative performance evaluation for automated external defibrillators. Resuscitation 2021; 160:94-102. [PMID: 33524490 DOI: 10.1016/j.resuscitation.2021.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to present new combination of algorithms for rhythm analysis during cardiopulmonary resuscitation (CPR) in automated external defibrillators (AED), called Analyze Whilst Compressing (AWC), designed for decreasing pre-shock pause and early stopping of chest compressions (CC) for treating refibrillation. METHODS Two stages for AED rhythm analysis were presented, namely, "Standard Analysis Stage" (conventional shock-advisory analysis run over 5 s after CC interruption every two minutes) and "AWC Stage" (two-step sequential analysis process during CPR). AWC steps were run in presence of CC (Step1), and if shockable rhythm was detected then a reconfirmation step was run in absence of CC (Step2, analysis duration 5 s). RESULTS In total 16,057 ECG strips from 2916 out-of-hospital cardiac arrest (OHCA) patients treated with AEDs (DEFIGARD TOUCH7, Schiller Médical, France) were subjected patient-wise to AWC training (8559 strips, 1604 patients) and validation (7498 strips, 1312 patients). Considering validation results, "Standard Analysis Stage" presented ventricular fibrillation (VF) sensitivity Se = 98.3% and non-shockable rhythm specificity Sp>99%; "AWC Stage" decision after Step2 reconfirmation achieved Se = 92.1%, Sp>99%. CONCLUSION AWC presented similar performances to other AED algorithms during CPR, fulfilling performance goals recommended by standards. AWC provided advances in the challenge for improving CPR quality by: (i) not interrupting chest compressions for prevalent part of non-shockable rhythms (66-83%); (ii) minimizing pre-shock pause for 92.1% of VF patients. AWC required hands-off reconfirmation in 34.4% of cases. Reconfirmation was also common limitation of other reported algorithms (25.7-100%) although following different protocols for triggering chest compression resumption and shock delivery.
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Affiliation(s)
| | - Sarah Ménétré
- Schiller Médical SAS, 4 rue L. Pasteur, F-67160 Wissembourg, France
| | - Irena Jekova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl 105, 1113 Sofia, Bulgaria
| | - Todor Stoyanov
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl 105, 1113 Sofia, Bulgaria
| | - Vessela Krasteva
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl 105, 1113 Sofia, Bulgaria.
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Jost D, Hong Tuan Ha V, Trichereau J, Frattini B, Derkenne C, Lemoine S, Lemoine F, Jouffroy R, Kedzierewicz R, Briche F, Diegelmann P, Bihannic R, Stibbe O, Prunet B. Contributing factors to early recurrence of ventricular fibrillation during out-of-hospital cardiac arrest: An observational retrospective study. Resuscitation 2020; 154:19-24. [DOI: 10.1016/j.resuscitation.2020.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
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Chicote B, Irusta U, Aramendi E, Alcaraz R, Rieta JJ, Isasi I, Alonso D, Baqueriza MDM, Ibarguren K. Fuzzy and Sample Entropies as Predictors of Patient Survival Using Short Ventricular Fibrillation Recordings during out of Hospital Cardiac Arrest. ENTROPY (BASEL, SWITZERLAND) 2018; 20:E591. [PMID: 33265680 PMCID: PMC7513119 DOI: 10.3390/e20080591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/23/2022]
Abstract
Optimal defibrillation timing guided by ventricular fibrillation (VF) waveform analysis would contribute to improved survival of out-of-hospital cardiac arrest (OHCA) patients by minimizing myocardial damage caused by futile defibrillation shocks and minimizing interruptions to cardiopulmonary resuscitation. Recently, fuzzy entropy (FuzzyEn) tailored to jointly measure VF amplitude and regularity has been shown to be an efficient defibrillation success predictor. In this study, 734 shocks from 296 OHCA patients (50 survivors) were analyzed, and the embedding dimension (m) and matching tolerance (r) for FuzzyEn and sample entropy (SampEn) were adjusted to predict defibrillation success and patient survival. Entropies were significantly larger in successful shocks and in survivors, and when compared to the available methods, FuzzyEn presented the best prediction results, marginally outperforming SampEn. The sensitivity and specificity of FuzzyEn were 83.3% and 76.7% when predicting defibrillation success, and 83.7% and 73.5% for patient survival. Sensitivities and specificities were two points above those of the best available methods, and the prediction accuracy was kept even for VF intervals as short as 2s. These results suggest that FuzzyEn and SampEn may be promising tools for optimizing the defibrillation time and predicting patient survival in OHCA patients presenting VF.
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Affiliation(s)
- Beatriz Chicote
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain
| | - Unai Irusta
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain
| | - Elisabete Aramendi
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha (UCLM), 16071 Cuenca, Spain
| | - José Joaquín Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politécnica de Valencia (UPV), 46022 Valencia, Spain
| | - Iraia Isasi
- Department of Communications Engineering, University of the Basque Country (UPV/EHU), 48013 Bilbao, Spain
| | - Daniel Alonso
- Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain
| | - María del Mar Baqueriza
- Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain
| | - Karlos Ibarguren
- Emergency Medical System (Emergentziak-Osakidetza), Basque Health Service, 20014 Donostia, Spain
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Bækgaard JS, Viereck S, Møller TP, Ersbøll AK, Lippert F, Folke F. The Effects of Public Access Defibrillation on Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review of Observational Studies. Circulation 2017; 136:954-965. [PMID: 28687709 DOI: 10.1161/circulationaha.117.029067] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/07/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite recent advances, the average survival after out-of-hospital cardiac arrest (OHCA) remains <10%. Early defibrillation by an automated external defibrillator is the most important intervention for patients with OHCA, showing survival proportions >50%. Accordingly, placement of automated external defibrillators in the community as part of a public access defibrillation program (PAD) is recommended by international guidelines. However, different strategies have been proposed on how exactly to increase and make use of publicly available automated external defibrillators. This systematic review aimed to evaluate the effect of PAD and the different PAD strategies on survival after OHCA. METHODS PubMed, Embase, and the Cochrane Library were systematically searched on August 31, 2015 for observational studies reporting survival to hospital discharge in OHCA patients where an automated external defibrillator had been used by nonemergency medical services. PAD was divided into 3 groups according to who applied the defibrillator: nondispatched lay first responders, professional first responders (firefighters/police) dispatched by the Emergency Medical Dispatch Center (EMDC), or lay first responders dispatched by the EMDC. RESULTS A total of 41 studies were included; 18 reported PAD by nondispatched lay first responders, 20 reported PAD by EMDC-dispatched professional first responders (firefighters/police), and 3 reported both. We identified no qualified studies reporting survival after PAD by EMDC-dispatched lay first responders. The overall survival to hospital discharge after OHCA treated with PAD showed a median survival of 40.0% (range, 9.1-83.3). Defibrillation by nondispatched lay first responders was associated with the highest survival with a median survival of 53.0% (range, 26.0-72.0), whereas defibrillation by EMDC-dispatched professional first responders (firefighters/police) was associated with a median survival of 28.6% (range, 9.0-76.0). A meta-analysis of the different survival outcomes could not be performed because of the large heterogeneity of the included studies. CONCLUSIONS This systematic review showed a median overall survival of 40% for patients with OHCA treated by PAD. Defibrillation by nondispatched lay first responders was found to correlate with the highest impact on survival in comparison with EMDC-dispatched professional first responders. PAD by EMDC-dispatched lay first responders could be a promising strategy, but evidence is lacking.
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Affiliation(s)
- Josefine S Bækgaard
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.).
| | - Søren Viereck
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Thea Palsgaard Møller
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Annette Kjær Ersbøll
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Freddy Lippert
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
| | - Fredrik Folke
- From Emergency Medical Services Copenhagen, University of Copenhagen, Denmark (J.S.B., S.V., T.P.M., F.L., F.F.); and National Institute of Public Health, University of Southern Denmark, Copenhagen (A.K.E.)
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Jin D, Dai C, Gong Y, Lu Y, Zhang L, Quan W, Li Y. Does the choice of definition for defibrillation and CPR success impact the predictability of ventricular fibrillation waveform analysis? Resuscitation 2016; 111:48-54. [PMID: 27951401 DOI: 10.1016/j.resuscitation.2016.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Quantitative analysis of ventricular fibrillation (VF), such as amplitude spectral area (AMSA), predicts shock outcomes. However, there is no uniform definition of shock/cardiopulmonary resuscitation (CPR) success in out-of-hospital cardiac arrest (OHCA). The objective of this study is to investigate post-shock rhythm variations and the impact of shock/CPR success definition on the predictability of AMSA. METHODS A total of 554 shocks from 257 OHCA patients with VF as initial rhythm were analyzed. Post-shock rhythms were analyzed every 5s up to 120s and annotated as VF, asystole (AS) and organized rhythm (OR) at serial time intervals. Three shock/CPR success definitions were used to evaluate the predictability of AMSA: (1) termination of VF (ToVF); (2) return of organized electrical activity (ROEA); (3) return of potentially perfusing rhythm (RPPR). RESULTS Rhythm changes occurred after 54.5% (N=302) of shocks and 85.8% (N=259) of them occurred within 60s after shock delivery. The observed post-shock rhythm changes were (1) from AS to VF (24.9%), (2) from OR to VF (16.1%), and (3) from AS to OR (12.1%). The area under the receiver operating characteristic curve (AUC) for AMSA as a predictor of shock/CPR success reached its maximum 60s post-shock. The AUC was 0.646 for ToVF, 0.782 for ROEA, and 0.835 for RPPR (p<0.001) respectively. CONCLUSIONS Post-shock rhythm is unstable in the first minute after the shock. The predictability of AMSA varies depending on the definition of shock/CPR success and performs best with the return of potentially perfusing rhythm endpoint for OHCA.
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Affiliation(s)
- Danian Jin
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China; Information Department, The 303th Hospital of PLA, Nanning, Guangxi 530021, China
| | - Chenxi Dai
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yushun Gong
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yubao Lu
- Emergency Department, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Lei Zhang
- Emergency Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Weilun Quan
- ZOLL Medical Corporation, Chelmsford, MA 01824, USA
| | - Yongqin Li
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China.
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Hong Tuan Ha V, Travers S, Jost D, Bignand M, Tourtier JP. Is time to recurrence of ventricular fibrillation a constant? Resuscitation 2015; 93:e9-10. [PMID: 26025567 DOI: 10.1016/j.resuscitation.2015.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Daniel Jost
- Paris Fire Brigade Emergency Medical Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U 970, Paris, France.
| | - Michel Bignand
- Paris Fire Brigade Emergency Medical Department, Paris, France
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