C Barton1, J E Manning, N Batson. 1. Department of Emergency Medicine, University of North Carolina-Chapel Hill, USA.
Abstract
STUDY OBJECTIVE: To determine whether the computer-derived measures of median frequency or peak amplitude of ventricular fibrillation (VF), obtained by fast Fourier transform of the VF waveform, change during selective aortic arch perfusion in a canine model of cardiac arrest. METHODS: Eight mongrel dogs (including 4 control animals) were sedated, intubated, catheterized, and instrumented to record the electrocardiogram (digitally at 100 Hz, filtered with a finite impulse response filter at 2 Hz), right atrial pressure, and aortic pressure during resuscitation in a model of VF-induced cardiac arrest. After 10 minutes of VF-induced arrest, cardiopulmonary resuscitation (CPR) with a mechanical chest compression device was initiated. Beginning 2 minutes later, the 4 study animals received, every 2 minutes, 45 seconds of selective aortic arch perfusion (SAAP) with autologous blood infusions under high pressure. Defibrillation was attempted after 3 minutes of CPR and every minute thereafter. Both study and control groups received standard-dose epinephrine (.01 mg/kg) every 3 minutes by means of an intraaortic catheter. The median frequency, peak amplitude, and coronary perfusion pressure (CPP) during the 5-second period just before defibrillation were obtained with the use of computer algorithms. RESULTS: All SAAP animals and 1 control animal were resuscitated. Baseline measures of median frequency (8.4 +/- 1.5 versus 6.6 +/- 1.0 Hz) and peak amplitude (.18 +/- .05 versus .36 +/- .13 mV) were not different between the SAAP and control groups, respectively, at the start of CRP. SAAP infusion resulted in significant increases in the SAAP group compared with the control group: median frequency, 9.6 +/- .4 versus 7.3 +/- 1.4 Hz; peak amplitude, .74 +/- .21 versus .39 +/- .15 mV; and CPP, 40.5 +/- 7.1 versus 18.0 +/- 15.0 mm Hg, respectively. Median frequency correlated with CPP (r2 = .67). Peak amplitude did not correlate with CPP (r2 = .06). CONCLUSION: Median frequency and peak amplitude increase with SAAP during cardiac arrest in a canine model. This method of resuscitation was reliable in allowing restoration of a stable perfusing rhythm after defibrillation. Changes in measures of peak amplitude and median frequency may reflect interventions that enhance the likelihood of successful defibrillation and may thereby offer a noninvasive means of monitoring interventions during cardiac arrest.
STUDY OBJECTIVE: To determine whether the computer-derived measures of median frequency or peak amplitude of ventricular fibrillation (VF), obtained by fast Fourier transform of the VF waveform, change during selective aortic arch perfusion in a canine model of cardiac arrest. METHODS: Eight mongrel dogs (including 4 control animals) were sedated, intubated, catheterized, and instrumented to record the electrocardiogram (digitally at 100 Hz, filtered with a finite impulse response filter at 2 Hz), right atrial pressure, and aortic pressure during resuscitation in a model of VF-induced cardiac arrest. After 10 minutes of VF-induced arrest, cardiopulmonary resuscitation (CPR) with a mechanical chest compression device was initiated. Beginning 2 minutes later, the 4 study animals received, every 2 minutes, 45 seconds of selective aortic arch perfusion (SAAP) with autologous blood infusions under high pressure. Defibrillation was attempted after 3 minutes of CPR and every minute thereafter. Both study and control groups received standard-dose epinephrine (.01 mg/kg) every 3 minutes by means of an intraaortic catheter. The median frequency, peak amplitude, and coronary perfusion pressure (CPP) during the 5-second period just before defibrillation were obtained with the use of computer algorithms. RESULTS: All SAAP animals and 1 control animal were resuscitated. Baseline measures of median frequency (8.4 +/- 1.5 versus 6.6 +/- 1.0 Hz) and peak amplitude (.18 +/- .05 versus .36 +/- .13 mV) were not different between the SAAP and control groups, respectively, at the start of CRP. SAAP infusion resulted in significant increases in the SAAP group compared with the control group: median frequency, 9.6 +/- .4 versus 7.3 +/- 1.4 Hz; peak amplitude, .74 +/- .21 versus .39 +/- .15 mV; and CPP, 40.5 +/- 7.1 versus 18.0 +/- 15.0 mm Hg, respectively. Median frequency correlated with CPP (r2 = .67). Peak amplitude did not correlate with CPP (r2 = .06). CONCLUSION: Median frequency and peak amplitude increase with SAAP during cardiac arrest in a canine model. This method of resuscitation was reliable in allowing restoration of a stable perfusing rhythm after defibrillation. Changes in measures of peak amplitude and median frequency may reflect interventions that enhance the likelihood of successful defibrillation and may thereby offer a noninvasive means of monitoring interventions during cardiac arrest.
Authors: Jostein Rødseth Brede; Thomas Lafrenz; Andreas J Krüger; Edmund Søvik; Torjus Steffensen; Carlo Kriesi; Martin Steinert; Pål Klepstad Journal: BMJ Open Date: 2019-05-09 Impact factor: 2.692