Danian Jin1, Chenxi Dai2, Yushun Gong2, Yubao Lu3, Lei Zhang4, Weilun Quan5, Yongqin Li6. 1. School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China; Information Department, The 303th Hospital of PLA, Nanning, Guangxi 530021, China. 2. School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China. 3. Emergency Department, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China. 4. Emergency Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. 5. ZOLL Medical Corporation, Chelmsford, MA 01824, USA. 6. School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China. Electronic address: leeoken@gmail.com.
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.
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.
Authors: Jason Coult; Jennifer Blackwood; Lawrence Sherman; Thomas D Rea; Peter J Kudenchuk; Heemun Kwok Journal: Circ Arrhythm Electrophysiol Date: 2019-01
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