Analysis of amplitude spectral area and slope to predict defibrillation in out of hospital cardiac arrest due to ventricular fibrillation (VF) according to VF type: Recurrent versus shock-resistant

Shanmugasundaram, Madhan; Valles, Amanda; Kellum, Michael J.; Ewy, Gordon A.; Indik, Julia H.

doi:10.1016/j.resuscitation.2012.02.008

Cited by 23 publications

(17 citation statements)

References 16 publications

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“…[7][8][9][10][11] This investigation similarly finds that VF recurrence is a common event, occurring in our investigation after about three quarters of successful defibrillatory shocks and with early VF recurrence within 30 seconds in about one third of shocks. We also found that the postshock pause before resumption of CC after a successful defibrillatory shock was highly variable, with a median time of 8 seconds (interquartile range, 5-18 seconds) and exceeding 30 seconds in about one quarter of successful shocks wherein VF recurred within 30 seconds (Table 2).…”

Section: Discussionsupporting

confidence: 76%

“…VF recurrence is common during resuscitation, [7][8][9][10][11] and the triggers are unclear. In an analysis of cardiac arrest survivors in the Netherlands, 12 it was found that VF was highly likely to recur within the first 2 seconds after the reinitiation of CC, regardless of whether CCs were resumed immediately after the shock or delayed for a postshock rhythm analysis.…”

Section: Clinical Perspective On P 639mentioning

confidence: 99%

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Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest

Conover

Kern

Silver

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Prior investigation of out-of-hospital cardiac arrest has raised the concern that ventricular fibrillation (VF) recurrence may be triggered by chest compression (CC) resumption. We investigated predictors of VF recurrence after defibrillation, including timing of CC resumption. Methods and Results-Patients with witnessed out-of-hospital cardiac arrest and initial rhythm of VF from an Utstein-style database were analyzed. For each shock that defibrillated VF, CC resumption and VF recurrence times were determined. Shocks were classified according to postshock rhythm. Factors (age, sex, time from dispatch to monitor/defibrillator application, and CC resumption) that could predict VF recurrence were analyzed. CC resumption was categorized into groups: CC1, 1 to 5 seconds; CC2, 6 to 10 seconds; CC3, 11 to 30 seconds; and CC4, >30 seconds. Eighty-eight subjects were analyzed, with a total of 285 shocks, with 226 shocks that achieved asystole (n=102), organized rhythm (n=120), or monomorphic ventricular tachycardia (n=4). After a successful shock, CC resumption occurred at a median (interquartile range) of 8 (5-18)

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Section: Discussionsupporting

confidence: 76%

Section: Clinical Perspective On P 639mentioning

confidence: 99%

Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest

Conover

Kern

Silver

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…12 Indeed, evidence exists for ventricular fibrillation (VF) waveform changes over time, which might enable prediction of the success of a defibrillation attempt. 4,[12][13][14][15][16][17] Small clinical studies have demonstrated that amplitude spectrum area (AMSA) is one of the most accurate predictors of defibrillation success. 16,17 However, none of these studies reported any patients'…”

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confidence: 99%

Amplitude Spectrum Area to Guide Defibrillation

et al. 2015

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Background-This study sought to validate the ability of amplitude spectrum area (AMSA) to predict defibrillation success and long-term survival in a large population of out-of-hospital cardiac arrests. Methods and Results-ECGs recorded by automated external defibrillators from different manufacturers were obtained from patients with cardiac arrests occurring in 8 city areas. A database, including 2447 defibrillations from 1050 patients, was used as the derivation group, and an additional database, including 1381 defibrillations from 567 patients, served as validation. A 2-second ECG window before defibrillation was analyzed, and AMSA was calculated. Univariable and multivariable regression analyses and area under the receiver operating characteristic curve were used for associations between AMSA and study end points: defibrillation success, sustained return of spontaneous circulation, and long-term survival. Among the 2447 defibrillations of the derivation database, 26.2% were successful. AMSA was significantly higher before a successful defibrillation than a failing one (13±5 versus 6.8±3.5 mV-Hz) and was an independent predictor of defibrillation success (odds ratio, 1.33; 95% confidence interval, 1.20-1.37) and sustained return of spontaneous circulation (odds ratio, 1.22; 95% confidence interval, 1.17-1.26). Area under the receiver operating characteristic curve for defibrillation success prediction was 0.86 (95% confidence interval, 0.85-0.88). AMSA was also significantly associated with long-term survival. The following AMSA thresholds were identified: 15.5 mV-Hz for defibrillation success and 6.5 mV-Hz for defibrillation failure. In the validation database, AMSA ≥15.5 mV-Hz had a positive predictive value of 84%, whereas AMSA ≤6.5 mV-Hz had a negative predictive value of 98%. Conclusions-In this large derivation-validation study, AMSA was validated as an accurate predictor of defibrillation success. AMSA also appeared as a predictor of long-term survival. (Circulation. 2015;131:478-487.

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“…22 In the frequency domain, after computing the FFT points (1024) of the magnitude spectrum, the amplitude spectral area (AMSA), measured in mV Hz, was calculated as the summed product of amplitude and frequency from 4 Hz to 48 Hz; 22 the dominant frequency (DF) was the frequency at which the absolute spectral maximum occurs; 23 and the median frequency (MF) was determined as the frequency that divides the power spectrum into two equal areas, and reflects changes in power and frequency over time. 23 In the time domain, the slope parameter (Slope) was calculated as the median of the absolute value of differences in signal voltage every 12Yms within the 4.1Ys window; 24 and RMS amplitude value was calculated by the root-mean-squared amplitude of the VF waveform within the 4.1Yms window. 25 Episodes in which the pre or post defibrillation rhythm could not be satisfactorily determined were excluded from the final analysis.…”

Section: Vf Waveform Metricsmentioning

confidence: 99%

A support vector machine for predicting defibrillation outcomes from waveform metrics

Howe

Escalona

Maio³

et al. 2014

Resuscitation

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Analysis of amplitude spectral area and slope to predict defibrillation in out of hospital cardiac arrest due to ventricular fibrillation (VF) according to VF type: Recurrent versus shock-resistant

Cited by 23 publications

References 16 publications

Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest

Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest

Amplitude Spectrum Area to Guide Defibrillation

A support vector machine for predicting defibrillation outcomes from waveform metrics

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