Signal Analysis of the Human Electrocardiogram During Ventricular Fibrillation: Frequency and Amplitude Parameters as Predictors of Successful Countershock☆,☆☆,★,★★,♢
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INTRODUCTION
Laboratory studies have shown that the success of electrical countershock in converting ventricular fibrillation (VF) to a supraventricular perfusing rhythm decreases with increasing durations of ischemia.1 More recently, in a second laboratory investigation the effect of immediate countershock versus epinephrine administration after 7.5 minutes of VF in a canine model of cardiac arrest was studied.2 In this study, when immediate countershock was followed by advanced cardiac life support
MATERIALS AND METHODS
This study was a retrospective analysis of ECG cassette recordings made during cardiac arrest. The study population comprised a convenience sample of 55 patients with out-of-hospital cardiac arrest in whom the initial ECG rhythm was identified as VF.
Patients in this study were monitored with a semiautomatic defibrillator/ECG monitor equipped with an ECG and voice cassette recorder (HeartAid 1000, HeartStart 1000, and HeartStart 2000; Laerdal). The ECG signals were reviewed with a HeartStart
RESULTS
Our patient population comprised 55 patients, who received a total of 324 countershocks. Of these countershocks, only 128 were free of artifact or had sufficient clinical information with which we could determine the result of the countershock and could therefore be used for analysis. Nine of the 128 countershocks analyzed in this study were successful. These nine successful countershocks were performed in seven patients. One patient accounted for three successful countershocks.
The Table
DISCUSSION
The results of this study suggest that the FC and the combination of FC and FP of the VF ECG signal are predictive of successful countershock in human beings during cardiac arrest.
Although we found a statistical difference in the frequency parameter FC relative to countershock outcome, the successful and unsuccessful distributions of the parameter data overlapped to some extent. Even with a combination of FC and FP, the highest cut-off point frequencies for 100% sensitivity for predicting a
Acknowledgements
The authors thank Paul Pepe, MD; David Michael; Richard Kessler; David Cheng; Kevin Ackley; Eric Drobney; and Eric Knipple for their assistance in the technical preparation of this study.
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Cited by (91)
European Resuscitation Council Guidelines 2021: Adult advanced life support
2021, ResuscitationCitation Excerpt :Although there are no data supporting a three-shock strategy in any of these circumstances, it is unlikely that chest compressions will improve the already very high chance of ROSC when defibrillation occurs early in the electrical phase, immediately after onset of VF/pVT (expert opinion). It is possible to predict, with varying reliability, the success of defibrillation from the fibrillation waveform.148–170 If optimal defibrillation waveforms and the optimal timing of shock delivery can be determined in prospective studies, it should be possible to prevent the delivery of unsuccessful high energy shocks and minimise myocardial injury.
Predicting defibrillation success in out-of-hospital cardiac arrested patients: Moving beyond feature design
2020, Artificial Intelligence in MedicineDiagnosis of shockable rhythms for automated external defibrillators using a reliable support vector machine classifier
2018, Biomedical Signal Processing and Control
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From the Departments of Emergency Medicine* and Anesthesiology‡, Ohio State University, Columbus, Ohio.
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Supported in part by a grant from Michigan Instruments, Incorporated.
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A patent for the technology discussed in this article has been sought by Ohio State University and has been licensed to Michigan Instruments, Incorporated
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Address for reprints: Charles G Brown, MD, Department of Emergency Medicine, Ohio State University, 005 Upham Hall, 473 West 12th Avenue, Columbus, Ohio 43210, 614-293-8305, Fax 614-487-9584
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Reprint no. 47/1/71223