Qiyu Yang1, Ming Li1, Zhaolan Huang1, Zhuoyan Xie1, Yue Wang2, Qin Ling2, Xuefen Liu2, Wanchun Tang2,3, Longyuan Jiang2, Zhengfei Yang2,3,4. 1. School of Automation, Guangdong University of Technology, Guangzhou 510006, China. 2. Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. 3. Weil Institute of Emergency and Critical Care Research, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA. 4. Department of Emergency Medicine, Zengcheng District People's Hospital of Guangzhou, Guangzhou 511300, China.
Abstract
BACKGROUND: The amplitude spectrum area (AMSA), a frequency-domain ventricular fibrillation (VF) waveform metric, can predict successful defibrillation and the return of spontaneous circulation (ROSC) after defibrillation attempts. We aimed to investigate the validation of Spectral Energy for the quantitative analysis of the VF waveform to guide defibrillation in a porcine model of cardiac arrest and compare it with the AMSA metric. In addition, we sought to determine the effects of epinephrine and cardiopulmonary resuscitation (CPR) on AMSA and Spectral Energy. METHODS: Sixty male domestic pigs weighing 35 to 45 kg were involved in this study. VF was initially untreated for 10 min followed by 6 min of CPR. Epinephrine was administered to the animals after 2 min of CPR. After the CPR, a single 120-J biphasic shock was applied to the animals. AMSA and Spectral Energy values were measured every minute from the electrocardiogram (ECG) to defibrillation. Receiver operating characteristic (ROC) curves were calculated for both the Spectral Energy and AMSA methods. RESULTS: Spectral Energy and AMSA values gradually decayed during untreated VF in all the animals. However, after the application of CPR and epinephrine, Spectral Energy and AMSA values were significantly increased in animals which were later successfully defibrillated, but did not increase in animals in which defibrillation was unsuccessful. The ROC curves showed that the Spectral Energy and AMSA methods possessed similar levels of sensitivity and specificity in predicting defibrillation success (P<0.001). CONCLUSIONS: Both the Spectral Energy and AMSA methods accurately predict successful defibrillation. Moreover, increases in the value of either Spectral Energy or AMSA after application of CPR and epinephrine may also predict successful defibrillation. 2019 Journal of Thoracic Disease. All rights reserved.
BACKGROUND: The amplitude spectrum area (AMSA), a frequency-domain ventricular fibrillation (VF) waveform metric, can predict successful defibrillation and the return of spontaneous circulation (ROSC) after defibrillation attempts. We aimed to investigate the validation of Spectral Energy for the quantitative analysis of the VF waveform to guide defibrillation in a porcine model of cardiac arrest and compare it with the AMSA metric. In addition, we sought to determine the effects of epinephrine and cardiopulmonary resuscitation (CPR) on AMSA and Spectral Energy. METHODS: Sixty male domestic pigs weighing 35 to 45 kg were involved in this study. VF was initially untreated for 10 min followed by 6 min of CPR. Epinephrine was administered to the animals after 2 min of CPR. After the CPR, a single 120-J biphasic shock was applied to the animals. AMSA and Spectral Energy values were measured every minute from the electrocardiogram (ECG) to defibrillation. Receiver operating characteristic (ROC) curves were calculated for both the Spectral Energy and AMSA methods. RESULTS: Spectral Energy and AMSA values gradually decayed during untreated VF in all the animals. However, after the application of CPR and epinephrine, Spectral Energy and AMSA values were significantly increased in animals which were later successfully defibrillated, but did not increase in animals in which defibrillation was unsuccessful. The ROC curves showed that the Spectral Energy and AMSA methods possessed similar levels of sensitivity and specificity in predicting defibrillation success (P<0.001). CONCLUSIONS: Both the Spectral Energy and AMSA methods accurately predict successful defibrillation. Moreover, increases in the value of either Spectral Energy or AMSA after application of CPR and epinephrine may also predict successful defibrillation. 2019 Journal of Thoracic Disease. All rights reserved.
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