Course of quantitative ventricular fibrillation waveform measure and outcome following out-of-hospital cardiac arrest

Schoene, Peter; Coult, Jason; Murphy, Lauren; Fahrenbruch, Carol; Blackwood, Jennifer; Kudenchuk, Peter J.; Sherman, Lawrence; Rea, Thomas D.

doi:10.1016/j.hrthm.2013.10.049

Cited by 39 publications

(30 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30 Indeed, in our study, AMSA also appeared as a predictor of long-term survival. Although we have not assessed neurological outcome in our population, patients who arrived alive at hospital admission and then survived until hospital discharge and up to 1 year after resuscitation presented significantly higher AMSA during CPR compared with those who died earlier.…”

Section: 9-11supporting

confidence: 55%

Amplitude Spectrum Area to Guide Defibrillation

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Section: 9-11supporting

confidence: 55%

Amplitude Spectrum Area to Guide Defibrillation

et al. 2015

View full text Add to dashboard Cite

show abstract

“…8). Recent data by Schoene et al also highlights the role of AMSA over the course of the first 3 shocks during resuscitation in predicting survival and FNP in a large retrospective cohort of patients with out-of-hospital cardiac arrest due to VF [28]. Calculation of AMSA will typically provide higher AMSA values in traces with more high-frequency content, which agrees with our results based on DF.…”

Section: Discussionsupporting

confidence: 90%

“…Additionally, a significant number of traces were not available on admission, which may raise the concern of selection bias. However, our results are consistent with previous studies, which reduce likelihood for such bias [13,15,27,28]. In the future, either incorporating the algorithm into external defibrillators or automated signal transferring from defibrillators to portable medical devices, for signal processing and risk score calculation, may avoid such limitation.…”

Section: Limitationssupporting

confidence: 91%

Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status

Filgueiras-Rama

Calvo

Salvador-Montañés

et al. 2015

International Journal of Cardiology

View full text Add to dashboard Cite

Background Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. Methods Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive model was developed in a retrospective cohort (n=32; September 2006–September 2011, 48.5 ± 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011–July 2013, 5 ± 1.8 months of follow-up). Results FNP was present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p < 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity= 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic ≥ 0.89. Conclusions A spectral analysis-based model reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest.

show abstract

“…AMSA has been related to ROSC in human cohorts in Japan 26 , and Norway 30 using a similar parameter called slope. AMSA has been studied for survival in a cohort of 390 patients with OHCA finding that a good neurological outcome was associated with higher AMSA values 12 and associated with long term survival in a cohort in Italy 14 . This investigation adds further support to these findings, as we confirm that AMSA predicts a good neurological outcome, and furthermore that the predictive utility of AMSA is independent CC quality.…”

Section: Discussionmentioning

confidence: 99%

“…It remains unclear what other features may explain these differences in survival. In an investigation of 390 patients with VF cardiac arrest 12 , the amplitude-spectral area (AMSA) measured from the VF waveform indicated survival with a good neurological outcome. This was confirmed in a cohort of witnessed VF cardiac arrest in Arizona that showed AMSA was associated with hospital discharge and identified a threshold for AMSA below which survival was highly unlikely 13 .…”

Section: Introductionmentioning

confidence: 99%