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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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| Published in: | The Journal of emergency medicine 2015-03, Vol.48 (3), p.373-381 |
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| container_title | The Journal of emergency medicine |
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| creator | McGovern, Meghan, MS Allen, Daniel, MS Chaudhry, Fahd, MD Conover, Zacherie, BS Hilwig, Ronald, MS, PhD, DVM Indik, Julia H., MD, PhD |
| description | 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 |
| doi_str_mv | 10.1016/j.jemermed.2014.09.057 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1661331843</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S073646791401097X</els_id><sourcerecordid>1661331843</sourcerecordid><originalsourceid>FETCH-LOGICAL-c489t-63a4aa5e121d109860b53ec93aa8c4055c956ea9d4a7421720d8ab82ace4f6ee3</originalsourceid><addsrcrecordid>eNqFkU9v1DAQxS0EotvCV6h85JLgf3HsC2K1sIBUBFJL4WZ5nYnWaRIvdlLUb1-H7V64cJrDvDdv5jcIXVJSUkLl267sYIA4QFMyQkVJdEmq-hlaMV6xoiJMP0crUnNZCFnrM3SeUkcIrYmiL9EZq4RSgvIVSjd7wLcwTtG7ubcRb_0u-r63kw8j_mnvoQ1xwOvDIQbr9ngK-IOP4Cb8PaQp7YO7w5s9pAlvwnCIkFL2JexHbPH1Hz8C_hoa6HFo8e0Wr2NWTK_Qi9b2CV4_1Qv0Y_vxZvO5uPr26ctmfVU4ofRUSG6FtRVQRhtKtJJkV3FwmlurnCBV5XQlwepG2FowWjPSKLtTzDoQrQTgF-jNcW7e_fecg83gk4N83AhhToZKSTmnSvAslUepiyGlCK05RD_Y-GAoMQtw05kTcLMAN0SbDDwbL58y5t3SO9lOhLPg_VEA-dJ7D9Ek52F00PzFaJrg_5_x7p8Rrvejd7a_gwdIXZjjmDkaahIzxFwvb1--TgXJ3Opf_BHF8qrs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1661331843</pqid></control><display><type>article</type><title>The Ventricular Fibrillation Waveform Approach to Direct Postshock Chest Compressions in a Swine Model of VF Arrest</title><source>ScienceDirect Journals</source><creator>McGovern, Meghan, MS ; Allen, Daniel, MS ; Chaudhry, Fahd, MD ; Conover, Zacherie, BS ; Hilwig, Ronald, MS, PhD, DVM ; Indik, Julia H., MD, PhD</creator><creatorcontrib>McGovern, Meghan, MS ; Allen, Daniel, MS ; Chaudhry, Fahd, MD ; Conover, Zacherie, BS ; Hilwig, Ronald, MS, PhD, DVM ; Indik, Julia H., MD, PhD</creatorcontrib><description>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 < 0.001), and a threshold of 20 mV-Hz gave a sensitivity of 89%, with specificity of 29%. Conclusion Although AMSA predicts ROSC in a swine model of VF arrest in both AMI and normal swine, a waveform-guided approach that uses AMSA to direct postshock CC duration does not significantly shorten the time to ROSC or alter neurological outcome.</description><identifier>ISSN: 0736-4679</identifier><identifier>EISSN: 2352-5029</identifier><identifier>DOI: 10.1016/j.jemermed.2014.09.057</identifier><identifier>PMID: 25488413</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>The Journal of emergency medicine, 2015-03, Vol.48 (3), p.373-381</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-63a4aa5e121d109860b53ec93aa8c4055c956ea9d4a7421720d8ab82ace4f6ee3</citedby><cites>FETCH-LOGICAL-c489t-63a4aa5e121d109860b53ec93aa8c4055c956ea9d4a7421720d8ab82ace4f6ee3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25488413$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McGovern, Meghan, MS</creatorcontrib><creatorcontrib>Allen, Daniel, MS</creatorcontrib><creatorcontrib>Chaudhry, Fahd, MD</creatorcontrib><creatorcontrib>Conover, Zacherie, BS</creatorcontrib><creatorcontrib>Hilwig, Ronald, MS, PhD, DVM</creatorcontrib><creatorcontrib>Indik, Julia H., MD, PhD</creatorcontrib><title>The Ventricular Fibrillation Waveform Approach to Direct Postshock Chest Compressions in a Swine Model of VF Arrest</title><title>The Journal of emergency medicine</title><addtitle>J Emerg Med</addtitle><description>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 < 0.001), and a threshold of 20 mV-Hz gave a sensitivity of 89%, with specificity of 29%. Conclusion Although AMSA predicts ROSC in a swine model of VF arrest in both AMI and normal swine, a waveform-guided approach that uses AMSA to direct postshock CC duration does not significantly shorten the time to ROSC or alter neurological outcome.</description><subject>Algorithms</subject><subject>Animals</subject><subject>cardiopulmonary resuscitation</subject><subject>Cardiopulmonary Resuscitation - methods</subject><subject>defibrillation</subject><subject>Electric Countershock</subject><subject>Electrocardiography</subject><subject>Emergency</subject><subject>Female</subject><subject>heart arrest</subject><subject>Heart Arrest - etiology</subject><subject>Heart Arrest - therapy</subject><subject>Heart Massage</subject><subject>Male</subject><subject>Models, Animal</subject><subject>myocardial infarction</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Predictive Value of Tests</subject><subject>Swine</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>ventricular fibrillation</subject><subject>Ventricular Fibrillation - complications</subject><subject>Ventricular Fibrillation - physiopathology</subject><issn>0736-4679</issn><issn>2352-5029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkU9v1DAQxS0EotvCV6h85JLgf3HsC2K1sIBUBFJL4WZ5nYnWaRIvdlLUb1-H7V64cJrDvDdv5jcIXVJSUkLl267sYIA4QFMyQkVJdEmq-hlaMV6xoiJMP0crUnNZCFnrM3SeUkcIrYmiL9EZq4RSgvIVSjd7wLcwTtG7ubcRb_0u-r63kw8j_mnvoQ1xwOvDIQbr9ngK-IOP4Cb8PaQp7YO7w5s9pAlvwnCIkFL2JexHbPH1Hz8C_hoa6HFo8e0Wr2NWTK_Qi9b2CV4_1Qv0Y_vxZvO5uPr26ctmfVU4ofRUSG6FtRVQRhtKtJJkV3FwmlurnCBV5XQlwepG2FowWjPSKLtTzDoQrQTgF-jNcW7e_fecg83gk4N83AhhToZKSTmnSvAslUepiyGlCK05RD_Y-GAoMQtw05kTcLMAN0SbDDwbL58y5t3SO9lOhLPg_VEA-dJ7D9Ek52F00PzFaJrg_5_x7p8Rrvejd7a_gwdIXZjjmDkaahIzxFwvb1--TgXJ3Opf_BHF8qrs</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>McGovern, Meghan, MS</creator><creator>Allen, Daniel, MS</creator><creator>Chaudhry, Fahd, MD</creator><creator>Conover, Zacherie, BS</creator><creator>Hilwig, Ronald, MS, PhD, DVM</creator><creator>Indik, Julia H., MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150301</creationdate><title>The Ventricular Fibrillation Waveform Approach to Direct Postshock Chest Compressions in a Swine Model of VF Arrest</title><author>McGovern, Meghan, MS ; Allen, Daniel, MS ; Chaudhry, Fahd, MD ; Conover, Zacherie, BS ; Hilwig, Ronald, MS, PhD, DVM ; Indik, Julia H., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-63a4aa5e121d109860b53ec93aa8c4055c956ea9d4a7421720d8ab82ace4f6ee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Algorithms</topic><topic>Animals</topic><topic>cardiopulmonary resuscitation</topic><topic>Cardiopulmonary Resuscitation - methods</topic><topic>defibrillation</topic><topic>Electric Countershock</topic><topic>Electrocardiography</topic><topic>Emergency</topic><topic>Female</topic><topic>heart arrest</topic><topic>Heart Arrest - etiology</topic><topic>Heart Arrest - therapy</topic><topic>Heart Massage</topic><topic>Male</topic><topic>Models, Animal</topic><topic>myocardial infarction</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Predictive Value of Tests</topic><topic>Swine</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>ventricular fibrillation</topic><topic>Ventricular Fibrillation - complications</topic><topic>Ventricular Fibrillation - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McGovern, Meghan, MS</creatorcontrib><creatorcontrib>Allen, Daniel, MS</creatorcontrib><creatorcontrib>Chaudhry, Fahd, MD</creatorcontrib><creatorcontrib>Conover, Zacherie, BS</creatorcontrib><creatorcontrib>Hilwig, Ronald, MS, PhD, DVM</creatorcontrib><creatorcontrib>Indik, Julia H., MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McGovern, Meghan, MS</au><au>Allen, Daniel, MS</au><au>Chaudhry, Fahd, MD</au><au>Conover, Zacherie, BS</au><au>Hilwig, Ronald, MS, PhD, DVM</au><au>Indik, Julia H., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Ventricular Fibrillation Waveform Approach to Direct Postshock Chest Compressions in a Swine Model of VF Arrest</atitle><jtitle>The Journal of emergency medicine</jtitle><addtitle>J Emerg Med</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>48</volume><issue>3</issue><spage>373</spage><epage>381</epage><pages>373-381</pages><issn>0736-4679</issn><eissn>2352-5029</eissn><abstract>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 < 0.001), and a threshold of 20 mV-Hz gave a sensitivity of 89%, with specificity of 29%. Conclusion Although AMSA predicts ROSC in a swine model of VF arrest in both AMI and normal swine, a waveform-guided approach that uses AMSA to direct postshock CC duration does not significantly shorten the time to ROSC or alter neurological outcome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25488413</pmid><doi>10.1016/j.jemermed.2014.09.057</doi><tpages>9</tpages></addata></record> |
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| 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 |
| title | The Ventricular Fibrillation Waveform Approach to Direct Postshock Chest Compressions in a Swine Model of VF Arrest |
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