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Thannhauser J, Nas J, van der Sluijs K, Zwart H, de Boer MJ, van Royen N, Bonnes J, Brouwer M. Pilot study on VF-waveform based algorithms for early detection of acute myocardial infarction during out-of-hospital cardiac arrest. Resuscitation 2022; 174:62-67. [DOI: 10.1016/j.resuscitation.2022.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 12/23/2022]
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Nas J, van Dongen LH, Thannhauser J, Hulleman M, van Royen N, Tan HL, Bonnes JL, Koster RW, Brouwer MA, Blom MT. The effect of the localisation of an underlying ST-elevation myocardial infarction on the VF-waveform: A multi-centre cardiac arrest study. Resuscitation 2021; 168:11-18. [PMID: 34500021 DOI: 10.1016/j.resuscitation.2021.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In cardiac arrest, ventricular fibrillation (VF) waveform characteristics such as amplitude spectrum area (AMSA) are studied to identify an underlying myocardial infarction (MI). Observational studies report lower AMSA-values in patients with than without underlying MI. Moreover, experimental studies with 12-lead ECG-recordings show lowest VF-characteristics when the MI-localisation matches the ECG-recording direction. However, out-of-hospital cardiac arrest (OHCA)-studies with defibrillator-derived VF-recordings are lacking. METHODS Multi-centre (Amsterdam/Nijmegen, the Netherlands) cohort-study on the association between AMSA, ST-elevation MI (STEMI) and its localisation. AMSA was calculated from defibrillator pad-ECG recordings (proxy for lead II, inferior vantage point); STEMI-localisation was determined using ECG/angiography/autopsy findings. RESULTS We studied AMSA-values in 754 OHCA-patients. There were statistically significant differences between no STEMI, anterior STEMI and inferior STEMI (Nijmegen: no STEMI 13.0mVHz [7.9-18.6], anterior STEMI 7.5mVHz [5.6-13.8], inferior STEMI 7.5mVHz [5.4-11.8], p = 0.006. Amsterdam: 11.7mVHz [5.0-21.9], 9.6mVHz [4.6-17.2], and 6.9mVHz [3.2-16.0], respectively, p = 0.001). Univariate analyses showed significantly lower AMSA-values in inferior STEMI vs. no STEMI; there was no significant difference between anterior and no STEMI. After correction for confounders, adjusted absolute AMSA-values were numerically lowest for inferior STEMI in both cohorts, and the relative differences in AMSA between inferior and no STEMI was 1.4-1.7 times larger than between anterior and no STEMI. CONCLUSION This multi-centre VF-waveform OHCA-study showed significantly lower AMSA in case of underlying STEMI, with a more pronounced difference for inferior than for anterior STEMI. Confirmative studies on the impact of STEMI-localisation on the VF-waveform are warranted, and might contribute to earlier diagnosis of STEMI during VF.
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Affiliation(s)
- J Nas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - L H van Dongen
- Department of Cardiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - J Thannhauser
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - M Hulleman
- Department of Cardiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - H L Tan
- Department of Cardiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - J L Bonnes
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - R W Koster
- Department of Cardiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - M A Brouwer
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - M T Blom
- Department of Cardiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Yeh LR, Chen WC, Chan HY, Lu NH, Wang CY, Twan WH, Du WC, Huang YH, Hsu SY, Chen TB. Integrating ECG Monitoring and Classification via IoT and Deep Neural Networks. BIOSENSORS-BASEL 2021; 11:bios11060188. [PMID: 34201215 PMCID: PMC8226863 DOI: 10.3390/bios11060188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 12/24/2022]
Abstract
Anesthesia assessment is most important during surgery. Anesthesiologists use electrocardiogram (ECG) signals to assess the patient’s condition and give appropriate medications. However, it is not easy to interpret the ECG signals. Even physicians with more than 10 years of clinical experience may still misjudge. Therefore, this study uses convolutional neural networks to classify ECG image types to assist in anesthesia assessment. The research uses Internet of Things (IoT) technology to develop ECG signal measurement prototypes. At the same time, it classifies signal types through deep neural networks, divided into QRS widening, sinus rhythm, ST depression, and ST elevation. Three models, ResNet, AlexNet, and SqueezeNet, are developed with 50% of the training set and test set. Finally, the accuracy and kappa statistics of ResNet, AlexNet, and SqueezeNet in ECG waveform classification were (0.97, 0.96), (0.96, 0.95), and (0.75, 0.67), respectively. This research shows that it is feasible to measure ECG in real time through IoT and then distinguish four types through deep neural network models. In the future, more types of ECG images will be added, which can improve the real-time classification practicality of the deep model.
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Affiliation(s)
- Li-Ren Yeh
- Department of Anesthesiology, E-DA Cancer Hospital, I-Shou University, No. 65, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan;
- Department of Health and Beauty, Shu-Zen Junior College of Medicine and Management, No. 452, Huanqiu Road, Luzhu District, Kaohsiung City 82144, Taiwan
| | - Wei-Chin Chen
- Department of Anesthesiology, E-DA Hospital, I-Shou University, No. 1, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan;
| | - Hua-Yan Chan
- Department of Medical Radiology, E-DA Cancer Hospital, I-Shou University, No. 1, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan;
| | - Nan-Han Lu
- Department of Pharmacy, Tajen University, No. 20, Weixin Road, Yanpu Township, Pingtung County 90741, Taiwan;
- Department of Radiology, E-DA Hospital, I-Shou University, No. 1, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan; (C.-Y.W.); (Y.-H.H.)
| | - Chi-Yuan Wang
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan; (C.-Y.W.); (Y.-H.H.)
- Department of Radiology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, No. 553, Junxiao Rd., Zuoying District, Kaohsiung City 81342, Taiwan
| | - Wen-Hung Twan
- Department of Life Sciences, National Taitung University, No. 369, Sec. 2, University Road, Taitung 95092, Taiwan;
| | - Wei-Chang Du
- Department of Information Engineering, I-Shou University, No. 1, Sec. 1, Syuecheng Road, Dashu District, Kaohsiung City 84001, Taiwan;
| | - Yung-Hui Huang
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan; (C.-Y.W.); (Y.-H.H.)
| | - Shih-Yen Hsu
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan; (C.-Y.W.); (Y.-H.H.)
- Department of Information Engineering, I-Shou University, No. 1, Sec. 1, Syuecheng Road, Dashu District, Kaohsiung City 84001, Taiwan;
- Correspondence: (S.-Y.H.); (T.-B.C.)
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiao-su Village, Yan-chao District, Kaohsiung City 82445, Taiwan; (C.-Y.W.); (Y.-H.H.)
- Institute of Statistics, National Yang Ming Chiao Tung University, No. 1001, University Road, Hsinchu 30010, Taiwan
- Correspondence: (S.-Y.H.); (T.-B.C.)
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Bender D, Morgan RW, Nadkarni VM, Berg RA, Zhang B, Kilbaugh TJ, Sutton RM, Nataraj C. MLWAVE: A novel algorithm to classify primary versus secondary asphyxia-associated ventricular fibrillation. Resusc Plus 2021; 5:100052. [PMID: 33569548 PMCID: PMC7869586 DOI: 10.1016/j.resplu.2020.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION/HYPOTHESIS The outcome of cardiopulmonary resuscitation (CPR) depends on timely recognition of the underlying cause of cardiac arrest. Ventricular fibrillation (VF) waveform analysis to differentiate primary VF from secondary asphyxia-associated VF may allow tailoring of therapies to improve cardiac arrest outcomes. Therefore, the primary goal of this investigation was to develop a novel technique utilizing wavelet synchrosqueezed transform (WSST) and decision-tree classifier that was specifically adapted to discriminate between these two incidents of VF. METHODS Secondary analytical investigation of electrocardiography (ECG) data obtained from swine models of either primary VF (n=18) or secondary asphyxia-associated VF (7min of asphyxia prior to VF induction; n=12). In the primary analysis, WSST technique was applied to the first 35s of the VF ECG signal to identify the most differentiating characteristics of the signal for use as features to develop a machine learning algorithm to classify the arrest as either primary VF vs. secondary asphyxia-associated VF. The performance of this new interactive Machine Learning algorithm with Wavelet Energy features of ECG (MLWAVE) was assessed using both classification accuracy and area under the receiver operating characteristic curve (AUCROC). To evaluate the validity of the new technique, the amplitude spectrum area (AMSA)-based technique, a well-established defibrillation classification method, was also applied to the same ECG signals. The classification accuracy and AUCROC were then compared between the two techniques. RESULTS For the primary analysis evaluating the first 35s of the VF waveform, the MLWAVE technique classified the type of VF with high accuracy (28/28 [100%], AUCROC: 1.00). The MLWAVE technique performed better than the AMSA technique across all comparisons, but given the small sample sizes, differences were not statistically significant (accuracy: 100% vs. 85.7%; p=0.24; AUCROC: 1.00 vs. 0.82; p=0.24). CONCLUSION This analytical investigation illustrates the advantages of the MLWAVE signal processing method which was associated with 100% accuracy in classifying the type of VF waveform: primary vs. asphyxia-associated. Such classification could lead to personalized tailoring of resuscitation (e.g., immediate defibrillation vs. continued CPR and treatment of reversible cardiac arrest causes before defibrillation) to improve outcomes for cardiac arrest.
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Affiliation(s)
- Dieter Bender
- Villanova Center for Analytics of Dynamic Systems, Villanova University, Villanova, PA, USA
| | - Ryan W. Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Bingqing Zhang
- Healthcare Analytics Unit, Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Todd J. Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert M. Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - C. Nataraj
- Moritz Professor & Director, Villanova Center for Analytics of Dynamic Systems, Villanova University, Villanova, PA, USA
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Frigerio L, Baldi E, Aramendi E, Chicote B, Irusta U, Contri E, Palo A, Compagnoni S, Fracchia R, Iotti G, Oltrona Visconti L, Savastano S. End-tidal carbon dioxide (ETCO 2) and ventricular fibrillation amplitude spectral area (AMSA) for shock outcome prediction in out-of-hospital cardiac arrest. Are they two sides of the same coin? Resuscitation 2020; 160:142-149. [PMID: 33181229 DOI: 10.1016/j.resuscitation.2020.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022]
Abstract
AIM Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) are predictors of shock success, understood as restoration of an organized rhythm, and return of spontaneous circulation (ROSC). However, little is known about their combined use. We aimed to assess the prediction accuracy when combined, and to clarify if they are correlated in out of hospital cardiac arrest' victims. MATERIALS AND METHODS Records acquired by external defibrillators in out-of-hospital cardiac arrest patients of the Lombardia Cardiac Arrest registry were processed. The 1-min pre-shock ETCO2 median value (METCO2) was computed from the capnogram and AMSA (2-48 mV.Hz range) computed applying the Fast Fourier Transform to a 2-second pre-shock filtered ECG interval (0.5-30 Hz). Support Vector Machine (SVM) predictive models based on METCO2, AMSA and their combination were fit; results were given as the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. RESULTS We considered 112 patients with 391 shocks delivered. METCO2 and AMSA were predictors of shock success [AUC (IQR) of the ROC curve: 0.59 (0.56-0.62); 0.68 (0.65-0.72), respectively] and of ROSC [0.56 (0.53-0.59); 0.74 (0.71-0.78),]. Their combination in a SVM model increased the accuracy for predicting shock success [AUC (IQR) of the ROC curve: 0.71 (0.68-0.75)] and ROSC [0.77 (0.73-0.8)]. AMSA and METCO2 were significantly correlated only in patients who achieved ROSC (rho = 0.33 p = 0.03). CONCLUSIONS AMSA and ETCO2 predict shock success and ROSC after every shock, and their predictive power increases if combined. Notably, they were correlated only in patients who achieved ROSC.
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Affiliation(s)
- Laura Frigerio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Elisabete Aramendi
- Communications Engineering Department, University of the Basque Country UPV/EHU, Bilbao, Spain
| | - Beatriz Chicote
- Communications Engineering Department, University of the Basque Country UPV/EHU, Bilbao, Spain
| | - Unai Irusta
- Communications Engineering Department, University of the Basque Country UPV/EHU, Bilbao, Spain
| | - Enrico Contri
- AREU Azienda Regionale Emergenza Urgenza - AAT Pavia c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AREU Azienda Regionale Emergenza Urgenza - AAT Pavia c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Rosa Fracchia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giorgio Iotti
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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6
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Thannhauser J, Nas J, Rebergen DJ, Westra SW, Smeets JLRM, Van Royen N, Bonnes JL, Brouwer MA. Computerized Analysis of the Ventricular Fibrillation Waveform Allows Identification of Myocardial Infarction: A Proof-of-Concept Study for Smart Defibrillator Applications in Cardiac Arrest. J Am Heart Assoc 2020; 9:e016727. [PMID: 33003984 PMCID: PMC7792424 DOI: 10.1161/jaha.120.016727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background In cardiac arrest, computerized analysis of the ventricular fibrillation (VF) waveform provides prognostic information, while its diagnostic potential is subject of study. Animal studies suggest that VF morphology is affected by prior myocardial infarction (MI), and even more by acute MI. This experimental in‐human study reports on the discriminative value of VF waveform analysis to identify a prior MI. Outcomes may provide support for in‐field studies on acute MI. Methods and Results We conducted a prospective registry of implantable cardioverter defibrillator recipients with defibrillation testing (2010–2014). From 12‐lead surface ECG VF recordings, we calculated 10 VF waveform characteristics. First, we studied detection of prior MI with lead II, using one key VF characteristic (amplitude spectrum area [AMSA]). Subsequently, we constructed diagnostic machine learning models: model A, lead II, all VF characteristics; model B, 12‐lead, AMSA only; and model C, 12‐lead, all VF characteristics. Prior MI was present in 58% (119/206) of patients. The approach using the AMSA of lead II demonstrated a C‐statistic of 0.61 (95% CI, 0.54–0.68). Model A performance was not significantly better: 0.66 (95% CI, 0.59–0.73), P=0.09 versus AMSA lead II. Model B yielded a higher C‐statistic: 0.75 (95% CI, 0.68–0.81), P<0.001 versus AMSA lead II. Model C did not improve this further: 0.74 (95% CI, 0.67–0.80), P=0.66 versus model B. Conclusions This proof‐of‐concept study provides the first in‐human evidence that MI detection seems feasible using VF waveform analysis. Information from multiple ECG leads rather than from multiple VF characteristics may improve diagnostic accuracy. These results require additional experimental studies and may serve as pilot data for in‐field smart defibrillator studies, to try and identify acute MI in the earliest stages of cardiac arrest.
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Affiliation(s)
- Jos Thannhauser
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Joris Nas
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Dennis J Rebergen
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Sjoerd W Westra
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Joep L R M Smeets
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Niels Van Royen
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Judith L Bonnes
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
| | - Marc A Brouwer
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
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7
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Maury P, Duchateau J, Rollin A, Hocini M, Voglimacci-Stephanopoli Q, Monteil B, Sacher F, Jaïs P, Bernus O, Mondoly P, Delmas C, Haïssaguerre M, Dubois R. Long-Lasting Ventricular Fibrillation in Humans ECG Characteristics and Effect of Radiofrequency Ablation. Circ Arrhythm Electrophysiol 2020; 13:e008639. [PMID: 32911973 DOI: 10.1161/circep.120.008639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of ventricular fibrillation (VF) in humans are limited because of the short available duration. We sought to study surface ECG waveforms and effect of ablation in long-lasting VF in patients with left assist devices. METHODS Continuous 12-lead ECG of 5 episodes of long-lasting VF occurring in 3 patients with left ventricular assist device were analyzed. Spectral analysis (dominant frequency) and quantification of waveform amplitude, regularity (Unbiased Regularity Index), and complexity (Nondipolar Index) were performed over a median of 24 minutes of VF. Radiofrequency ablation was performed during VF in 2 patients. RESULTS There was a significant increase in dominant frequency between VF onset and termination but none of the other parameters significantly changed. Some VF parameters varied from patient to patient and from lead to lead. Dominant frequency decreased after radiofrequency ablation in both cases and VF terminated spontaneously shortly after ablation in one case. The previously incessant VFs in these 2 patients did not recur afterward. CONCLUSIONS VF rate increases over time in patients with left ventricular assist devices and is lowered by ablation. Long-lasting VF may be modified or even terminated by ablation.
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Affiliation(s)
- Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.).,Unité Inserm U 1048, Toulouse, France (P.M.)
| | - Josselin Duchateau
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Meleze Hocini
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | | | - Benjamin Monteil
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Frederic Sacher
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Pierre Jaïs
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Olivier Bernus
- LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Clément Delmas
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Michel Haïssaguerre
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Rémi Dubois
- LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
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Spoormans EM, Lemkes JS, Janssens GN, van der Hoeven NW, Bonnes JL, van Royen N. The role of coronary angiography in out-of-hospital cardiac arrest patients in the absence of ST-segment elevation: A literature review. Neth Heart J 2020; 28:108-114. [PMID: 32780340 PMCID: PMC7419423 DOI: 10.1007/s12471-020-01460-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of death. Although the aetiology of cardiac arrest can be diverse, the most common cause is ischaemic heart disease. Coronary angiography and percutaneous coronary intervention, if indicated, has been associated with improved long-term survival for patients with initial shockable rhythm. However, in patients without ST-segment elevation on the post-resuscitation electrocardiogram, the optimal timing of performing this invasive procedure is uncertain. One important challenge that clinicians face is to appropriately select patients that will benefit from immediate coronary angiography, yet avoid unnecessary delay of intensive care support and targeted temperature management. Observational studies have reported contradictory results and until recently, randomised trials were lacking. The Coronary Angiography after Cardiac Arrest without ST-segment elevation (COACT) was the first randomised trial that provided comparative information between coronary angiography treatment strategies. This literature review will provide the current knowledge and gaps in the literature regarding optimal care for patients successfully resuscitated from OHCA in the absence of ST-segment elevation and will primarily focus on the role and timing of coronary angiography in this high-risk patient population.
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Affiliation(s)
- E M Spoormans
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - J S Lemkes
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
| | - G N Janssens
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - N W van der Hoeven
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - J L Bonnes
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N van Royen
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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A machine learning algorithm to improve patient-centric pediatric cardiopulmonary resuscitation. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Thannhauser J, Nas J, van Grunsven P, Meinsma G, Zwart H, de Boer M, van Royen N, Bonnes J, Brouwer M. The ventricular fibrillation waveform in relation to shock success in early vs. late phases of out-of-hospital resuscitation. Resuscitation 2019; 139:99-105. [DOI: 10.1016/j.resuscitation.2019.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/08/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
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Amplitude spectrum area: The "clairvoyance" during resuscitation in the era of predictive medicine. Resuscitation 2017; 120:A5-A6. [PMID: 28928017 DOI: 10.1016/j.resuscitation.2017.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 11/23/2022]
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Hulleman M, Salcido DD, Menegazzi JJ, Souverein PC, Tan HL, Blom MT, Koster RW. Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest. Resuscitation 2017; 120:125-131. [PMID: 28844935 DOI: 10.1016/j.resuscitation.2017.08.219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/30/2017] [Accepted: 08/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Amplitude spectrum area (AMSA) of ventricular fibrillation (VF) has been associated with survival from out-of-hospital cardiac arrest (OHCA). Ischemic heart disease has been shown to change AMSA. We studied whether the association between AMSA and survival changes with acute ST-elevation myocardial infarction (STEMI) as cause of the OHCA and/or previous MI. METHODS Multivariate logistic regression with log-transformed AMSA of first artifact-free VF segment was used to assess the association between AMSA and survival, according to presence of STEMI or previous MI, adjusting for resuscitation characteristics, medication use and comorbidities. RESULTS Of 716 VF-patients included from an OHCA-registry in the Netherlands, 328 (46%) had STEMI as cause of OHCA. Previous MI was present in 186 (26%) patients. Survival was 66%; neither previous MI (P=0.11) nor STEMI (P=0.78) altered survival. AMSA was a predictor of survival (ORadj: 1.52, 95%-CI: 1.28-1.82). STEMI was associated with lower AMSA (8.4mV-Hz [3.7-16.5] vs. 12.3mV-Hz [5.6-23.0]; P<0.001), but previous MI was not (9.5mV-Hz [3.9-18.0] vs 10.6mV-Hz [4.6-19.3]; P=0.27). When predicting survival, there was no interaction between previous MI and AMSA (P=0.14). STEMI and AMSA had a significant interaction (P=0.002), whereby AMSA was no longer a predictor of survival (ORadj: 1.03, 95%-CI: 0.77-1.37) in STEMI-patients. In patients without STEMI, higher AMSA was associated with higher survival rates (ORadj: 1.80, 95%-CI: 1.39-2.35). CONCLUSIONS The prognostic value of AMSA is altered by the presence of STEMI: while AMSA has strong predictive value in patients without STEMI, AMSA is not a predictor of survival in STEMI-patients.
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Affiliation(s)
- Michiel Hulleman
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - David D Salcido
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James J Menegazzi
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick C Souverein
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rudolph W Koster
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Bonnes JL, Thannhauser J, Nas J, Westra SW, Jansen RM, Meinsma G, de Boer MJ, Smeets JL, Keuper W, Brouwer MA. Ventricular fibrillation waveform characteristics of the surface ECG: Impact of the left ventricular diameter and mass. Resuscitation 2017; 115:82-89. [DOI: 10.1016/j.resuscitation.2017.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 02/20/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
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