Beatriz Chicote1, Elisabete Aramendi2, Unai Irusta2, Pamela Owens3, Mohamud Daya4, Ahamed Idris3. 1. Communications Engineering Department, University of the Basque Country UPV/EHU, Ingeniero Torres Quevedo Plaza, 1, 48013 Bilbao, Spain. Electronic address: beatriz.chicote@ehu.eus. 2. Communications Engineering Department, University of the Basque Country UPV/EHU, Ingeniero Torres Quevedo Plaza, 1, 48013 Bilbao, Spain. 3. Department of Emergency Medicine, University of Texas Southwesterm Medical Center (UTSW), 5323 Harry Hines Blvd, Dallas, TX, USA. 4. Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA.
Abstract
BACKGROUND AND AIM: Unsuccessful defibrillation shocks adversely affect survival from out-of-hospital cardiac arrest (OHCA). Ventricular fibrillation (VF) waveform analysis is the tool-of-choice for the non-invasive prediction of shock success, but surrogate markers of perfusion like end-tidal CO2 (EtCO2) could improve the prediction. The aim of this study was to evaluate EtCO2 as predictor of shock success, both individually and in combination with VF-waveform analysis. MATERIALS AND METHODS: In total 514 shocks from 214 OHCA patients (75 first shocks) were analysed. For each shock three predictors of defibrillation success were automatically calculated from the device files: two VF-waveform features, amplitude spectrum area (AMSA) and fuzzy entropy (FuzzyEn), and the median EtCO2 (MEtCO2) in the minute before the shock. Sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated, for each predictor individually and for the combination of MEtCO2 and VF-waveform predictors. Separate analyses were done for first shocks and all shocks. RESULTS: MEtCO2 in first shocks was significantly higher for successful than for unsuccessful shocks (31mmHg/25mmHg, p<0.05), but differences were not significant for all shocks (32mmHg/29mmHg, p>0.05). MEtCO2 predicted shock success with an AUC of 0.66 for first shocks, but was not a predictor for all shocks (AUC 0.54). AMSA and FuzzyEn presented AUCs of 0.76 and 0.77 for first shocks, and 0.75 and 0.75 for all shocks. For first shocks, adding MEtCO2 improved the AUC of AMSA and FuzzyEn to 0.79 and 0.83, respectively. CONCLUSIONS: MEtCO2 predicted defibrillation success only for first shocks. Adding MEtCO2 to VF-waveform analysis in first shocks improved prediction of shock success. VF-waveform features and MEtCO2 were automatically calculated from the device files, so these methods could be introduced in current defibrillators adding only new software.
BACKGROUND AND AIM: Unsuccessful defibrillation shocks adversely affect survival from out-of-hospital cardiac arrest (OHCA). Ventricular fibrillation (VF) waveform analysis is the tool-of-choice for the non-invasive prediction of shock success, but surrogate markers of perfusion like end-tidal CO2 (EtCO2) could improve the prediction. The aim of this study was to evaluate EtCO2 as predictor of shock success, both individually and in combination with VF-waveform analysis. MATERIALS AND METHODS: In total 514 shocks from 214 OHCA patients (75 first shocks) were analysed. For each shock three predictors of defibrillation success were automatically calculated from the device files: two VF-waveform features, amplitude spectrum area (AMSA) and fuzzy entropy (FuzzyEn), and the median EtCO2 (MEtCO2) in the minute before the shock. Sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated, for each predictor individually and for the combination of MEtCO2 and VF-waveform predictors. Separate analyses were done for first shocks and all shocks. RESULTS:MEtCO2 in first shocks was significantly higher for successful than for unsuccessful shocks (31mmHg/25mmHg, p<0.05), but differences were not significant for all shocks (32mmHg/29mmHg, p>0.05). MEtCO2 predicted shock success with an AUC of 0.66 for first shocks, but was not a predictor for all shocks (AUC 0.54). AMSA and FuzzyEn presented AUCs of 0.76 and 0.77 for first shocks, and 0.75 and 0.75 for all shocks. For first shocks, adding MEtCO2 improved the AUC of AMSA and FuzzyEn to 0.79 and 0.83, respectively. CONCLUSIONS:MEtCO2 predicted defibrillation success only for first shocks. Adding MEtCO2 to VF-waveform analysis in first shocks improved prediction of shock success. VF-waveform features and MEtCO2 were automatically calculated from the device files, so these methods could be introduced in current defibrillators adding only new software.
Authors: Heitor P Povoas; Max Harry Weil; Wanchun Tang; Joe Bisera; Kada Klouche; Ann Barbatsis Journal: Resuscitation Date: 2002-04 Impact factor: 5.262
Authors: Mathieu Groulx; Alexandra Nadeau; Marcel Émond; Jessica Harrisson; Pierre-Gilles Blanchard; Douglas Eramian; Eric Mercier Journal: SAGE Open Med Date: 2021-06-30