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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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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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Hulleman M, Salcido DD, Menegazzi JJ, Souverein PC, Tan HL, Blom MT, Koster RW. Ventricular fibrillation waveform characteristics in out-of-hospital cardiac arrest and cardiovascular medication use. Resuscitation 2020; 151:173-180. [DOI: 10.1016/j.resuscitation.2020.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/19/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
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Mohindra R, Lin S. The drugs don’t matter: Cardiovascular drugs have minimal effects on amplitude spectral area during ventricular fibrillation. Resuscitation 2020; 151:205-207. [DOI: 10.1016/j.resuscitation.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
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End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest. Resuscitation 2017; 121:71-75. [DOI: 10.1016/j.resuscitation.2017.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/02/2017] [Accepted: 09/14/2017] [Indexed: 11/19/2022]
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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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Hidano D, Coult J, Blackwood J, Fahrenbruch C, Kwok H, Kudenchuk P, Rea T. Ventricular fibrillation waveform measures and the etiology of cardiac arrest. Resuscitation 2016; 109:71-75. [PMID: 27784613 DOI: 10.1016/j.resuscitation.2016.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/27/2016] [Accepted: 10/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early determination of the acute etiology of cardiac arrest could help guide resuscitation or post-resuscitation care. In experimental studies, quantitative measures of the ventricular fibrillation waveform distinguish ischemic from non-ischemic etiology. METHODS We investigated whether waveform measures distinguished arrest etiology among adults treated by EMS for out-of-hospital ventricular fibrillation between January 1, 2006-December 31, 2014. Etiology was classified using hospital information into three exclusive groups: acute coronary syndrome (ACS) with ST elevation myocardial infarction (STEMI), ACS without ST elevation (non-STEMI), or non-ischemic arrest. Waveform measures included amplitude spectrum area (AMSA), centroid frequency (CF), mean frequency (MF), and median slope (MS) assessed during CPR-free epochs immediately prior to the initial and second shock. Waveform measures prior to the initial shock and the changes between first and second shock were compared by etiology group. We a priori chose a significance level of 0.01 due to multiple comparisons. RESULTS Of the 430 patients, 35% (n=150) were classified as STEMI, 29% (n=123) as non-STEMI, and 37% (n=157) with non-ischemic arrest. We did not observe differences by etiology in any of the waveform measures prior to shock 1 (Kruskal-Wallis Test) (p=0.28 for AMSA, p=0.07 for CF, p=0.63 for MF, and p=0.39 for MS). We also did not observe differences for change in waveform between shock 1 and 2, or when the two acute ischemia groups (STEMI and non-STEMI) were combined and compared to the non-ischemic group. CONCLUSION This clinical investigation suggests that waveform measures may not be useful in distinguishing cardiac arrest etiology.
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Affiliation(s)
- Danelle Hidano
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Jason Coult
- Department of Bioengineering, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Jennifer Blackwood
- Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Carol Fahrenbruch
- Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Heemun Kwok
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Peter Kudenchuk
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States; Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Thomas Rea
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States; Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States.
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Ventricular fibrillation waveform characteristics differ according to the presence of a previous myocardial infarction: A surface ECG study in ICD-patients. Resuscitation 2015; 96:239-45. [DOI: 10.1016/j.resuscitation.2015.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/22/2015] [Accepted: 08/20/2015] [Indexed: 11/22/2022]
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10
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Bonnes JL, Keuper W, Westra SW, Zegers ES, Oostendorp TF, Brouwer MA, Smeets JL. Characteristics of ventricular fibrillation in relation to cardiac aetiology and shock success: A waveform analysis study in ICD-patients. Resuscitation 2015; 86:95-9. [DOI: 10.1016/j.resuscitation.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 09/17/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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The different faces of ventricular fibrillation. Resuscitation 2015; 86:A3-4. [DOI: 10.1016/j.resuscitation.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/09/2014] [Indexed: 11/17/2022]
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The ventricular fibrillation waveform approach to direct postshock chest compressions in a swine model of VF arrest. J Emerg Med 2014; 48:373-81. [PMID: 25488413 DOI: 10.1016/j.jemermed.2014.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 11/23/2022]
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.
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Association of amplitude spectral area of the ventricular fibrillation waveform with survival of out-of-hospital ventricular fibrillation cardiac arrest. J Am Coll Cardiol 2014; 64:1362-9. [PMID: 25257639 DOI: 10.1016/j.jacc.2014.06.1196] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous investigations of out-of-hospital cardiac arrest (OHCA) have shown that the waveform characteristic amplitude spectral area (AMSA) can predict successful defibrillation and return of spontaneous circulation (ROSC) but has not been studied previously for survival. OBJECTIVES To determine whether AMSA computed from the ventricular fibrillation (VF) waveform is associated with pre-hospital ROSC, hospital admission, and hospital discharge. METHODS Adults with witnessed OHCA and an initial rhythm of VF from an Utstein style database were studied. AMSA was measured prior to each shock and averaged for each subject (AMSA-avg). Factors such as age, sex, number of shocks, time from dispatch to monitor/defibrillator application, first shock AMSA, and AMSA-avg that could predict pre-hospital ROSC, hospital admission, and hospital discharge were analyzed by logistic regression. RESULTS Eighty-nine subjects (mean age 62 ± 15 years) with a total of 286 shocks were analyzed. AMSA-avg was associated with pre-hospital ROSC (p = 0.003); a threshold of 20.9 mV-Hz had a 95% sensitivity and a 43.4% specificity. Additionally, AMSA-avg was associated with hospital admission (p < 0.001); a threshold of 21 mV-Hz had a 95% sensitivity and a 54% specificity and with hospital discharge (p < 0.001); a threshold of 25.6 mV-Hz had a 95% sensitivity and a 53% specificity. First-shock AMSA was also predictive of pre-hospital ROSC, hospital admission, and discharge. Time from dispatch to monitor/defibrillator application was associated with hospital admission (p = 0.034) but not pre-hospital ROSC or hospital discharge. CONCLUSIONS AMSA is highly associated with pre-hospital ROSC, survival to hospital admission, and hospital discharge in witnessed VF OHCA. Future studies are needed to determine whether AMSA computed during resuscitation can identify patients for whom continuing current resuscitation efforts would likely be futile.
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Li X, Shao D, Wang G, Jiang T, Wu H, Gu B, Cao K, Zhang J, Qi L, Chen Y. Effects of different LAD-blocked sites on the development of acute myocardial infarction and malignant arrhythmia in a swine model. J Thorac Dis 2014; 6:1271-7. [PMID: 25276369 DOI: 10.3978/j.issn.2072-1439.2014.07.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/13/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To explore the effects of various left anterior descending (LAD) artery-blocked sites on the development of acute myocardial infarction (AMI) and malignant arrhythmia in a swine model. METHODS Twenty-two pigs underwent occlusion of the coronary artery with balloon angioplasty were randomly divided into three groups according to the blocked site of the balloon: middle-site-blocked LAD group, bottom-third-blocked LAD group and control group. Then, the development of AMI and malignant arrhythmia, including ventricular tachycardia and ventricular fibrillation during the process of model creation, were recorded. Changes of the hemodynamics, blood gas analysis, electrocardiography, and myocardial enzymes were analyzed in each group before and after occlusion. RESULTS Middle-site-LAD blockage resulted in a larger infarction size and the corresponding incidence of ventricular fibrillation was significantly higher than that of the bottom-third-blocked group (P<0.05). After the occlusion, the QTc interval of the Middle-site-blocked LAD group was significantly longer than that in the other groups (P<0.01). Moreover, mean arterial blood pressure (MAP), left ventricular ejection fraction (LVEF), and partial pressure of oxygen (PaO2) were significantly lower, but partial pressure of carbon dioxide (PaCO2) increased, in the Middle-site-blocked-LAD group compared with that in the bottom-third-blocked group (P<0.01). Compared with the control group, the two LAD-blocked groups showed significantly higher levels of Mb, CK-MB, LDH, AST and cTnT (P<0.01) four hours after the artery occlusion. However, these indexes were not significantly different between the two LAD-blocked groups (P>0.05). CONCLUSIONS Location of LAD blockages in swine models may affect the development of AMI and malignant arrhythmia.
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Affiliation(s)
- Xiaorong Li
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Danbing Shao
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Gannan Wang
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Ting Jiang
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Honghao Wu
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Bing Gu
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Kejiang Cao
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Jinsong Zhang
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Lianwen Qi
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
| | - Yan Chen
- 1 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 2 Department of Emergency, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China ; 3 Emergency Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 4 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 5 State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China
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Howe A, Escalona OJ, Di Maio R, Massot B, Cromie NA, Darragh KM, Adgey J, McEneaney DJ. A support vector machine for predicting defibrillation outcomes from waveform metrics. Resuscitation 2013; 85:343-9. [PMID: 24291591 DOI: 10.1016/j.resuscitation.2013.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/12/2013] [Accepted: 11/24/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Algorithms to predict shock success based on VF waveform metrics could significantly enhance resuscitation by optimising the timing of defibrillation. OBJECTIVE To investigate robust methods of predicting defibrillation success in VF cardiac arrest patients, by using a support vector machine (SVM) optimisation approach. METHODS Frequency-domain (AMSA, dominant frequency and median frequency) and time-domain (slope and RMS amplitude) VF waveform metrics were calculated in a 4.1Y window prior to defibrillation. Conventional prediction test validity of each waveform parameter was conducted and used AUC>0.6 as the criterion for inclusion as a corroborative attribute processed by the SVM classification model. The latter used a Gaussian radial-basis-function (RBF) kernel and the error penalty factor C was fixed to 1. A two-fold cross-validation resampling technique was employed. RESULTS A total of 41 patients had 115 defibrillation instances. AMSA, slope and RMS waveform metrics performed test validation with AUC>0.6 for predicting termination of VF and return-to-organised rhythm. Predictive accuracy of the optimised SVM design for termination of VF was 81.9% (± 1.24 SD); positive and negative predictivity were respectively 84.3% (± 1.98 SD) and 77.4% (± 1.24 SD); sensitivity and specificity were 87.6% (± 2.69 SD) and 71.6% (± 9.38 SD) respectively. CONCLUSIONS AMSA, slope and RMS were the best VF waveform frequency-time parameters predictors of termination of VF according to test validity assessment. This a priori can be used for a simplified SVM optimised design that combines the predictive attributes of these VF waveform metrics for improved prediction accuracy and generalisation performance without requiring the definition of any threshold value on waveform metrics.
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Affiliation(s)
- Andrew Howe
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK
| | - Omar J Escalona
- Centre for Advanced Cardiovascular Research (CACR), University of Ulster, Newtownabbey, UK.
| | | | - Bertrand Massot
- Institut des Nanotechnologies de Lyon, INSA-Lyon, Villeurbanne, France
| | - Nick A Cromie
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | | | - Jennifer Adgey
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - David J McEneaney
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK
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Stub D, Byrne M, Pellegrino V, Kaye DM. Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in a sheep model of refractory ischaemic cardiac arrest. Heart Lung Circ 2013; 22:421-7. [PMID: 23375811 DOI: 10.1016/j.hlc.2012.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Survival after out-of-hospital cardiac arrest remains limited. It is therefore imperative to develop new resuscitation techniques. We aimed to determine the potential role of extracorporeal membrane oxygenation assisted CPR (ECPR) in an animal model of refractory ischaemic cardiac arrest. METHODS Twelve sheep were assigned to either ECPR (n=6) or 'conventional' (n=6) resuscitation. All sheep had coronary occlusion, followed by induction of ventricular fibrillation (VF). CPR was than commenced for 10 min in both groups, followed by randomisation to ECPR or CPR for a further 10 min. At 23 min post induction of VF, advanced life support measures were commenced with direct cardioversion, adrenaline and amiodarone. Outcomes measures included rates of return of spontaneous circulation (ROSC), and analysis of VF wave form. RESULTS Baseline haemodynamics were similar between the two groups. CPR consistently produced coronary perfusion pressures (CPP) greater than 15 mmHg in both groups, with significantly increased CPP post commencement of ECMO in the ECPR group (17.84±2 mmHg vs 22.94±3 mmHg, p=0.04). Number of shocks, pH, lactate and oxygenation were also comparable. Significantly greater rates of ROSC were seen in the ECPR sheep, 3/6 (50%) vs 0/6 (0%) (p=0.032), which was also associated with significantly increased VF amplitude measures (0.51±0.08 mV vs 0.42±0.06 mV, p=0.04). CONCLUSIONS This study indicates that ECPR increases return of circulation and coronary perfusion pressure in a sheep model of ischaemic VF arrest. Our findings have supported the development of a pilot trial into the effectiveness and feasibility of ECPR in the clinical setting.
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Affiliation(s)
- Dion Stub
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
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Beta-blockade causes a reduction in the frequency spectrum of VF but improves resuscitation outcome: A potential limitation of quantitative waveform measures. Resuscitation 2012; 83:511-6. [DOI: 10.1016/j.resuscitation.2011.09.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/10/2011] [Accepted: 09/26/2011] [Indexed: 11/21/2022]
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Schultz J, Segal N, Kolbeck J, McKnite S, Caldwell E, Yannopoulos D. Sodium nitroprusside enhanced cardiopulmonary resuscitation (SNPeCPR) improves vital organ perfusion pressures and carotid blood flow in a porcine model of cardiac arrest. Resuscitation 2012; 83:374-7. [PMID: 21864483 PMCID: PMC3244558 DOI: 10.1016/j.resuscitation.2011.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 07/19/2011] [Accepted: 07/26/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY To describe a new method of CPR that optimizes vital organ perfusion pressures and carotid blood flow. We tested the hypothesis that a combination of high dose sodium nitroprusside (SNP) as well as non-invasive devices and techniques known independently to enhance circulation would significantly improve carotid blood flow (CBF) and return of spontaneous circulation (ROSC) rates in a porcine model of cardiac arrest. METHODS 15 isofluorane anesthetized pigs (30±1 kg), after 6 min of untreated ventricular fibrillation, were subsequently randomized to receive either 15 min of standard CPR (S-CPR) (8 animals) or 5 min epochs of S-CPR followed by active compression-decompression (ACD)+inspiratory impedance threshold device (ITD) CPR followed by ACD+ITD+abdominal binding (AB) with 1mg of SNP administered at minutes 2, 7, 12 of CPR (7 animals). Primary endpoints were CBF and ROSC rates. ANOVA and Fisher's exact test were used for comparisons. RESULTS/CONCLUSION There was significant improvement in the hemodynamic parameters in the SNP animals. ROSC was achieved in 7/7 animals that received SNP and in 2/8 in the S-CPR (p=0.007). CBF and end tidal CO(2) (ETCO(2)) were significantly higher in the ACD+ITD+AB+SNP (SNPeCPR) animals during CPR. Bolus doses of SNP, when used in conjunction with ACD+ITD+AB CPR, significantly improve CBF and ROSC rates compared to S-CPR.
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Affiliation(s)
- Jason Schultz
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Nowak CN, Neurauter A, Wieser L, Wenzel V, Abella B, Myklebust H, Steen PA, Strohmenger HU. Prediction of countershock success in patients using the autoregressive spectral estimation. Methods Inf Med 2011; 51:13-20. [PMID: 21643621 DOI: 10.3414/me10-01-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 01/29/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Ventricular fibrillation (VF) is a life-threatening cardiac arrhythmia and within of minutes of its occurrence, optimal timing of countershock therapy is highly warranted to improve the chance of survival. This study was designed to investigate whether the autoregressive (AR) estimation technique was capable to reliably predict countershock success in VF cardiac arrest patients. METHODS ECG data of 1077 countershocks applied to 197 cardiac arrest patients with out-of-hospital and in-hospital cardiac arrest between March 2002 and July 2004 were retrospectively analyzed. The ECG from the 2.5 s interval of the precountershock VF ECG was used for computing the AR based features Spectral Pole Power (SPP) and Spectral Pole Power with Dominant Frequency weighing (SPPDF) and Centroid Frequency (CF) and Amplitude Spectrum Area (AMSA) based on Fast Fourier Transformation (FFT). RESULTS With ROC AUC values up to 84.1% and diagnostic odds ratio up to 19.12 AR based features SPP and SPPDF have better prediction power than the FFT based features CF (80.5%; 6.56) and AMSA (82.1%; 8.79). CONCLUSIONS AR estimation based features are promising alternatives to FFT based features for countershock outcome when analyzing human data.
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Affiliation(s)
- C N Nowak
- Institute of Biomedical Engineering, University for Health Science, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1/G3, 6060 Hall in Tirol, Austria.
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Indik JH, Allen D, Gura M, Dameff C, Hilwig RW, Kern KB. Utility of the Ventricular Fibrillation Waveform to Predict a Return of Spontaneous Circulation and Distinguish Acute From Post Myocardial Infarction or Normal Swine in Ventricular Fibrillation Cardiac Arrest. Circ Arrhythm Electrophysiol 2011; 4:337-43. [DOI: 10.1161/circep.110.960419] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julia H. Indik
- From the Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ
| | - Daniel Allen
- From the Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ
| | - Michael Gura
- From the Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ
| | - Christian Dameff
- From the Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ
| | - Ronald W. Hilwig
- From the Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ
| | - Karl B. Kern
- From the Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ
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Quantitative measures of the ventricular fibrillation waveform and resuscitation outcome. Crit Care Med 2010; 38:2416-7. [PMID: 21088511 DOI: 10.1097/ccm.0b013e3181fd6724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ding C, Gepstein L, Nguyen DT, Wilson E, Hulley G, Beaser A, Lee RJ, Olgin J. High-resolution optical mapping of ventricular tachycardia in rats with chronic myocardial infarction. Pacing Clin Electrophysiol 2010; 33:687-95. [PMID: 20180914 DOI: 10.1111/j.1540-8159.2010.02704.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) is a common cause of mortality in post-myocardial infarction (MI) patients, even in the current era of coronary revascularization treatment. We report a reproducible VT model in rats with chronic MI induced by ischemia-reperfusion and describe its electrophysiological characteristics using high-resolution optical mapping. METHODS An MI was generated by left anterior descending coronary ligation (25 minutes) followed by reperfusion in 20 rats. Electrophysiology study and optical mapping were performed 5 weeks later using a Langendorff-perfused preparation and compared to normal rats. RESULTS The conduction velocity of the MI border zone was decreased to 53% of the normal areas remote from the infarct (0.37 +/- 0.16 m/sec vs 0.70 +/- 0.09 m/sec, P < 0.0001). The rate of VT inducibility in MI rats was significantly greater than in normal control rats (70% vs 0%, P = 0.00002). VT circuits involving the infarct area were identified with optical mapping in 83% MI rats. In addition, fixed and functional conduction block were observed in the infarct border zone. CONCLUSION This ischemia-reperfusion MI rat model is a reliable VT model, which simulates clinical revascularization treatment. High-resolution optical mapping in this model is useful to study the mechanism of VT and evaluate the effects of therapies.
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Affiliation(s)
- Chunhua Ding
- Cardiac Electrophysiology and Cardiovascular Research Institute, University of California, San Francisco, California 94143, USA
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Indik JH, Shanmugasundaram M, Allen D, Valles A, Kern KB, Hilwig RW, Zuercher M, Berg RA. Predictors of resuscitation outcome in a swine model of VF cardiac arrest: A comparison of VF duration, presence of acute myocardial infarction and VF waveform. Resuscitation 2009; 80:1420-3. [PMID: 19804932 DOI: 10.1016/j.resuscitation.2009.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 08/25/2009] [Accepted: 08/31/2009] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Factors that affect resuscitation to a perfusing rhythm (ROSC) following ventricular fibrillation (VF) include untreated VF duration, acute myocardial infarction (AMI), and possibly factors reflected in the VF waveform. We hypothesized that resuscitation of VF to ROSC within 3min is predicted by the VF waveform, independent of untreated VF duration or presence of acute MI. METHODS AMI was induced by the occlusion of the left anterior descending coronary artery. VF was induced in normal (N=30) and AMI swine (N=30). Animals were resuscitated after untreated VF of brief (2min) or prolonged (8min) duration. VF waveform was analyzed before the first shock to compute the amplitude-spectral area (AMSA) and slope. RESULTS Unadjusted predictors of ROSC within 3min included untreated VF duration (8min vs 2min; OR 0.11, 95%CI 0.02-0.54), AMI (AMI vs normal; OR 0.11, 95%CI 0.02-0.54), AMSA (highest to lowest tertile; OR 15.5, 95%CI 1.7-140), and slope (highest to lowest tertile; OR 12.7, 95%CI 1.4-114). On multivariate regression, untreated VF duration (P=0.011) and AMI (P=0.003) predicted ROSC within 3min. Among secondary outcome variables, favorable neurological status at 24h was only predicted by VF duration (OR 0.22, 95% CI 0.05-0.92). CONCLUSIONS In this swine model of VF, untreated VF duration and AMI were independent predictors of ROSC following VF cardiac arrest. AMSA and slope predicted ROSC when VF duration or the presence of AMI were unknown. Importantly, the initial treatment of choice for short duration VF is defibrillation regardless of VF waveform.
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Affiliation(s)
- Julia H Indik
- The Sarver Heart Center, The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724-5037, United States.
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Indik JH, Hilwig RW, Zuercher M, Kern KB, Berg MD, Berg RA. Preshock cardiopulmonary resuscitation worsens outcome from circulatory phase ventricular fibrillation with acute coronary artery obstruction in swine. Circ Arrhythm Electrophysiol 2009; 2:179-84. [PMID: 19808463 DOI: 10.1161/circep.108.824862] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some clinical studies have suggested that chest compressions before defibrillation improve survival in cardiac arrest because of prolonged ventricular fibrillation (VF; ie, within the circulatory phase). Animal data have also supported this conclusion, and we have previously demonstrated that preshock chest compressions increase the VF median frequency and improve the likelihood of a return of spontaneous circulation in normal swine. We hypothesized that chest compressions before defibrillation in a swine model of acute myocardial ischemia would also increase VF median frequency and improve resuscitation outcome. METHODS AND RESULTS Twenty-six swine were subjected to balloon occlusion of the left anterior descending coronary artery for 2 hours. The balloon was removed and VF was induced and untreated for 8 minutes. Swine were then treated with up to 3 stacked defibrillation shocks (n=13, shock-first group) or 3 minutes of chest compressions before shock (n=13, preshock cardiopulmonary resuscitation group). In the preshock cardiopulmonary resuscitation group, median frequency was increased from 7.0+/-0.8 to 13.9+/-1.6 Hz after chest compressions (P=0.002). Despite the improved median frequency in the preshock cardiopulmonary resuscitation group, 24-hour survival with favorable neurological status was significantly worse in the preshock cardiopulmonary resuscitation group (1/13) compared with the shock-first group (8/13, P=0.01). CONCLUSIONS In a swine model of prolonged VF in acute myocardial ischemia, 24-hour survival with favorable neurological status was more likely when defibrillation was performed first without preceding chest compressions. Myocardial substrate is an important factor in determining the optimal resuscitation strategy.
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Affiliation(s)
- Julia H Indik
- Sarver Heart Center, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona 85724-5037, USA.
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Sanchez-Munoz JJ, Rojo-Alvarez JL, Garcia-Alberola A, Everss E, Alonso-Atienza F, Ortiz M, Martinez-Sanchez J, Ramos-Lopez J, Valdes-Chavarri M. Spectral analysis of intracardiac electrograms during induced and spontaneous ventricular fibrillation in humans. Europace 2009; 11:328-31. [DOI: 10.1093/europace/eun366] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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