Jason Coult1, Lawrence Sherman2, Heemun Kwok3, Jennifer Blackwood4, Peter J Kudenchuk5, Thomas D Rea6. 1. Department of Bioengineering, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA. Electronic address: jasonc4@uw.edu. 2. Department of Bioengineering, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 3. Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 4. Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Seattle King County Department of Public Health, Seattle, WA, USA. 5. Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Seattle King County Department of Public Health, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA. 6. Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Seattle King County Department of Public Health, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Abstract
AIM: Quantitative waveform measures of the ventricular fibrillation (VF) electrocardiogram (ECG) predict defibrillation outcome. Calculation requires an ECG epoch without chest compression artifact. However, pauses in CPR can adversely affect survival. Thus the potential use of waveform measures is limited by the need to pause CPR. We sought to characterize the relationship between the length of the CPR-free epoch and the ability to predict outcome. METHODS: We conducted a retrospective investigation using the CPR-free ECG prior to first shock among out-of-hospital VF cardiac arrest patients in a large metropolitan region (n=442). Amplitude Spectrum Area (AMSA) and Median Slope (MS) were calculated using ECG epochs ranging from 5s to 0.2s. The relative ability of the measures to predict return of organized rhythm (ROR) and neurologically-intact survival was evaluated at different epoch lengths by calculating the area under the receiver operating characteristic curve (AUC) using the 5-s epoch as the referent group. RESULTS: Compared to the 5-s epoch, AMSA performance declined significantly only after reducing epoch length to 0.2s for ROR (AUC 0.77-0.74, p=0.03) and with epochs of ≤0.6s for neurologically-intact survival (AUC 0.72-0.70, p=0.04). MS performance declined significantly with epochs of ≤0.8s for ROR (AUC 0.78-0.77, p=0.04) and with epochs ≤1.6s for neurologically-intact survival (AUC 0.72-0.71, p=0.04). CONCLUSION: Waveform measures predict defibrillation outcome using very brief ECG epochs, a quality that may enable their use in current resuscitation algorithms designed to limit CPR interruption. Copyright Â
AIM: Quantitative waveform measures of the ventricular fibrillation (VF) electrocardiogram (ECG) predict defibrillation outcome. Calculation requires an ECG epoch without chest compression artifact. However, pauses in CPR can adversely affect survival. Thus the potential use of waveform measures is limited by the need to pause CPR. We sought to characterize the relationship between the length of the CPR-free epoch and the ability to predict outcome. METHODS: We conducted a retrospective investigation using the CPR-free ECG prior to first shock among out-of-hospital VF cardiac arrestpatients in a large metropolitan region (n=442). Amplitude Spectrum Area (AMSA) and Median Slope (MS) were calculated using ECG epochs ranging from 5s to 0.2s. The relative ability of the measures to predict return of organized rhythm (ROR) and neurologically-intact survival was evaluated at different epoch lengths by calculating the area under the receiver operating characteristic curve (AUC) using the 5-s epoch as the referent group. RESULTS: Compared to the 5-s epoch, AMSA performance declined significantly only after reducing epoch length to 0.2s for ROR (AUC 0.77-0.74, p=0.03) and with epochs of ≤0.6s for neurologically-intact survival (AUC 0.72-0.70, p=0.04). MS performance declined significantly with epochs of ≤0.8s for ROR (AUC 0.78-0.77, p=0.04) and with epochs ≤1.6s for neurologically-intact survival (AUC 0.72-0.71, p=0.04). CONCLUSION: Waveform measures predict defibrillation outcome using very brief ECG epochs, a quality that may enable their use in current resuscitation algorithms designed to limit CPR interruption. Copyright Â
Authors: Jason Coult; Heemun Kwok; Lawrence Sherman; Jennifer Blackwood; Peter J Kudenchuk; Thomas D Rea Journal: J Electrocardiol Date: 2017-08-01 Impact factor: 1.438
Authors: Beatriz Chicote; Unai Irusta; Elisabete Aramendi; Raúl Alcaraz; José Joaquín Rieta; Iraia Isasi; Daniel Alonso; María Del Mar Baqueriza; Karlos Ibarguren Journal: Entropy (Basel) Date: 2018-08-09 Impact factor: 2.524
Authors: Jasmeet Soar; Bernd W Böttiger; Pierre Carli; Keith Couper; Charles D Deakin; Therese Djärv; Carsten Lott; Theresa Olasveengen; Peter Paal; Tommaso Pellis; Gavin D Perkins; Claudio Sandroni; Jerry P Nolan Journal: Notf Rett Med Date: 2021-06-08 Impact factor: 0.826
Authors: Jasmeet Soar; Katherine M Berg; Lars W Andersen; Bernd W Böttiger; Sofia Cacciola; Clifton W Callaway; Keith Couper; Tobias Cronberg; Sonia D'Arrigo; Charles D Deakin; Michael W Donnino; Ian R Drennan; Asger Granfeldt; Cornelia W E Hoedemaekers; Mathias J Holmberg; Cindy H Hsu; Marlijn Kamps; Szymon Musiol; Kevin J Nation; Robert W Neumar; Tonia Nicholson; Brian J O'Neil; Quentin Otto; Edison Ferreira de Paiva; Michael J A Parr; Joshua C Reynolds; Claudio Sandroni; Barnaby R Scholefield; Markus B Skrifvars; Tzong-Luen Wang; Wolfgang A Wetsch; Joyce Yeung; Peter T Morley; Laurie J Morrison; Michelle Welsford; Mary Fran Hazinski; Jerry P Nolan Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262
Authors: Jos Thannhauser; Joris Nas; Priya Vart; Joep L R M Smeets; Menko-Jan de Boer; Niels van Royen; Judith L Bonnes; Marc A Brouwer Journal: Resusc Plus Date: 2021-04-02
Authors: Salvatore Aiello; Michelle Perez; Chad Cogan; Alvin Baetiong; Steven A Miller; Jeejabai Radhakrishnan; Christopher L Kaufman; Raúl J Gazmuri Journal: J Am Heart Assoc Date: 2017-11-04 Impact factor: 5.501