Ventricular fibrillation waveform measures combined with prior shock outcome predict defibrillation success during cardiopulmonary resuscitation

Jason Coult; Heemun Kwok; Lawrence Sherman; Jennifer Blackwood; Peter J Kudenchuk; Thomas D Rea

doi:10.1016/j.jelectrocard.2017.07.016

Ventricular fibrillation waveform measures combined with prior shock outcome predict defibrillation success during cardiopulmonary resuscitation

J Electrocardiol. 2018 Jan-Feb;51(1):99-106. doi: 10.1016/j.jelectrocard.2017.07.016. Epub 2017 Aug 1.

Authors

Jason Coult¹, Heemun Kwok², Lawrence Sherman³, Jennifer Blackwood⁴, Peter J Kudenchuk⁵, Thomas D Rea⁶

Affiliations

¹ Department of Bioengineering, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA. Electronic address: [email protected].
² Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: [email protected].
³ Department of Bioengineering, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: [email protected].
⁴ Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Seattle King County Department of Public Health, Seattle, WA, USA. Electronic address: [email protected].
⁵ Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; King County Emergency Medical Services, Seattle King County Department of Public Health, Seattle, WA, USA. Electronic address: [email protected].
⁶ Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; King County Emergency Medical Services, Seattle King County Department of Public Health, Seattle, WA, USA. Electronic address: [email protected].

Abstract

Aim: Amplitude Spectrum Area (AMSA) and Median Slope (MS) are ventricular fibrillation (VF) waveform measures that predict defibrillation shock success. Cardiopulmonary resuscitation (CPR) obscures electrocardiograms and must be paused for analysis. Studies suggest waveform measures better predict subsequent shock success when combined with prior shock success. We determined whether this relationship applies during CPR.

Methods: AMSA and MS were calculated from 5-second pre-shock segments with and without CPR, and compared to logistic models combining each measure with prior return of organized rhythm (ROR).

Results: VF segments from 692 patients were analyzed during CPR before 1372 shocks and without CPR before 1283 shocks. Combining waveform measures with prior ROR increased areas under receiver operating characteristic curves for AMSA/MS with CPR (0.66/0.68 to 0.73/0.74, p<0.001) and without CPR (0.71/0.72 to 0.76/0.76, p<0.001).

Conclusions: Prior ROR improves prediction of shock success during CPR, and may enable waveform measure calculation without chest compression pauses.

Keywords: Amplitude Spectrum Area; Cardiopulmonary resuscitation; Defibrillation; Resuscitation; Ventricular fibrillation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiopulmonary Resuscitation*
Electric Countershock*
Electrocardiography*
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / etiology
Out-of-Hospital Cardiac Arrest / therapy*
Prognosis
ROC Curve
Treatment Outcome
Ventricular Fibrillation / complications
Ventricular Fibrillation / diagnosis
Ventricular Fibrillation / physiopathology*
Ventricular Fibrillation / therapy

Grants and funding

T32 EB001650/EB/NIBIB NIH HHS/United States