Real‐Time Ventricular Fibrillation Amplitude‐Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine

Autor: Jeejabai Radhakrishnan, Michelle Perez, Salvatore Aiello, Raúl J. Gazmuri, Alvin Baetiong, Chad Cogan, Christopher L. Kaufman, Steven A. Miller
Rok vydání: 2017
Předmět:
Male
Resuscitation
medicine.medical_specialty
Time Factors
Translational Studies
Defibrillation
medicine.medical_treatment
Sus scrofa
resuscitation
Electric Countershock
Action Potentials
030204 cardiovascular system & hematology
Return of spontaneous circulation
Resuscitation Science
Sudden Cardiac Death
03 medical and health sciences
waveform analysis
0302 clinical medicine
Heart Rate
sudden cardiac arrest
Internal medicine
Heart rate
Animals
Medicine
Cardiopulmonary resuscitation
Original Research
Cardiopulmonary Resuscitation and Emergency Cardiac Care
business.industry
animal model
Signal Processing
Computer-Assisted
030208 emergency & critical care medicine
Sudden cardiac arrest
Recovery of Function
ventricular fibrillation
medicine.disease
Cardiopulmonary Resuscitation
defibrillation
amplitude spectral area
Disease Models
Animal
Amplitude
Animal Models of Human Disease
ventricular fibrillation waveform analysis
Ventricular fibrillation
Cardiology
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Algorithms
Defibrillators
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background The ventricular fibrillation amplitude spectral area (AMSA) predicts whether an electrical shock could terminate ventricular fibrillation and prompt return of spontaneous circulation. We hypothesized that AMSA can guide more precise timing for effective shock delivery during cardiopulmonary resuscitation. Methods and Results Three shock delivery protocols were compared in 12 pigs each after electrically induced ventricular fibrillation, with the duration of untreated ventricular fibrillation evenly stratified into 6, 9, and 12 minutes: AMSA‐Driven (AD), guided by an AMSA algorithm; Guidelines‐Driven (GD), according to cardiopulmonary resuscitation guidelines; and Guidelines‐Driven/AMSA‐Enabled (GDAE), as per GD but allowing earlier shocks upon exceeding an AMSA threshold. Shocks delivered using the AD, GD, and GDAE protocols were 21, 40, and 62, with GDAE delivering only 2 AMSA‐enabled shocks. The corresponding 240‐minute survival was 8/12, 6/12, and 2/12 (log‐rank test, P =0.035) with AD exceeding GDAE ( P =0.026). The time to first shock (seconds) was (median [Q1–Q3]) 272 (161–356), 124 (124–125), and 125 (124–125) ( P P P =0.002) with AD exceeding GDAE ( P P P Conclusions The AD protocol improved the time precision for shock delivery, resulting in less shock burden and less postresuscitation myocardial dysfunction, potentially improving survival compared with time‐fixed, guidelines‐driven, shock delivery protocols.
Databáze: OpenAIRE
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