The Ventricular Fibrillation Waveform Approach to Direct Postshock Chest Compressions in a Swine Model of VF Arrest

Abstract Background In retrospective swine and human investigations of ventricular fibrillation (VF) cardiac arrest, the amplitude-spectral area (AMSA), determined from the VF waveform, can predict defibrillation and a return of spontaneous circulation (ROSC). Objectives We hypothesized that an algo...

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Bibliographic Details
Published in:The Journal of emergency medicine 2015-03, Vol.48 (3), p.373-381
Main Authors: McGovern, Meghan, MS, Allen, Daniel, MS, Chaudhry, Fahd, MD, Conover, Zacherie, BS, Hilwig, Ronald, MS, PhD, DVM, Indik, Julia H., MD, PhD
Format: Article
Language:English
Subjects:
Algorithms
Animals
cardiopulmonary resuscitation
Cardiopulmonary Resuscitation - methods
defibrillation
Electric Countershock
Electrocardiography
Emergency
Female
heart arrest
Heart Arrest - etiology
Heart Arrest - therapy
Heart Massage
Male
Models, Animal
myocardial infarction
Myocardial Infarction - complications
Myocardial Infarction - physiopathology
Predictive Value of Tests
Swine
Time Factors
Treatment Outcome
ventricular fibrillation
Ventricular Fibrillation - complications
Ventricular Fibrillation - physiopathology
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Summary:Abstract Background In retrospective swine and human investigations of ventricular fibrillation (VF) cardiac arrest, the amplitude-spectral area (AMSA), determined from the VF waveform, can predict defibrillation and a return of spontaneous circulation (ROSC). Objectives We hypothesized that an algorithm using AMSA in real time to direct postshock chest compression (CC) duration would shorten the time to ROSC and improve neurological outcome in a swine model of VF cardiac arrest with acute myocardial infarction (AMI) or nonischemic myocardium. Methods AMI was induced by occlusion of the left anterior descending artery. VF was untreated for 10 min. Animals were randomized to either traditional resuscitation with 2 min of CC after each shock or to an AMSA-guided algorithm where postshock CCs were shortened to 1 min if the preshock AMSA exceeded 20 mV-Hz. Results A total of 48 animals were studied, 12 in each group (AMI vs. normal, and traditional vs. AMSA-guided). There was a nonsignificant shorter time to ROSC with an AMSA-guided approach in AMI swine (17.2 ± 3.4 vs. 18.5 ± 4.7 min, p  = NS), and in normal swine (13.5 ± 1.1 vs. 14.4 ± 1.2, p  = NS). Neurological outcome was similar between traditional and AMSA-guided animals. AMSA predicted ROSC ( p  
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2014.09.057