1
|
Yoshikawa Y, Ogino Y, Okai T, Oya H, Hoshi Y, Nakano K. Prediction of the effect of electrical defibrillation by using spectral feature parameters. Comput Biol Med 2024; 182:109123. [PMID: 39244961 DOI: 10.1016/j.compbiomed.2024.109123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 08/13/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024]
Abstract
This paper proposes a system for predicting the effect of electrical defibrillation using spectral feature parameters. The proposed method consists of two-stage prediction. The first stage involves predicting whether electrical defibrillation is "Successful" or "Ineffective." As the next stage, if the proposed prediction system determines "Ineffective," the proposed system discriminates between "VF recurrence" or "Failure" for electrical defibrillation. To develop the prediction system, feature parameters for the target electrocardiograms (ECGs) were first extracted by using the wavelet transform and spectral analysis. Next, effective feature parameters for prediction are selected through an analysis of variance. Moreover, in the preprocessing phase, the Synthetic Minority Oversampling Technique method and standardization are introduced. Finally, support vector machines with some kernel functions and the regularization method are utilized to predict the three states, i.e., "Successful," "Failure," and "VF recurrence," for electrical defibrillation in two phases. In this paper, we present our analysis method for ECGs and evaluate the effectiveness of the proposed prediction system.
Collapse
Affiliation(s)
- Y Yoshikawa
- Tokyo City University, 1-28-1 Tamazutsumi, Setagaya-ku, 158-8557, Tokyo, Japan.
| | - Y Ogino
- The University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, 182-8585, Tokyo, Japan
| | - T Okai
- Tokyo City University, 1-28-1 Tamazutsumi, Setagaya-ku, 158-8557, Tokyo, Japan
| | - H Oya
- Tokyo City University, 1-28-1 Tamazutsumi, Setagaya-ku, 158-8557, Tokyo, Japan
| | - Y Hoshi
- Tokyo City University, 1-28-1 Tamazutsumi, Setagaya-ku, 158-8557, Tokyo, Japan
| | - K Nakano
- The University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, 182-8585, Tokyo, Japan
| |
Collapse
|
2
|
Urteaga J, Elola A, Norvik A, Unneland E, Eftestøl TC, Bhardwaj A, Buckler D, Abella BS, Skogvoll E, Aramendi E. Machine learning model to predict evolution of pulseless electrical activity during in-hospital cardiac arrest. Resusc Plus 2024; 17:100598. [PMID: 38497047 PMCID: PMC10940985 DOI: 10.1016/j.resplu.2024.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background During pulseless electrical activity (PEA) the cardiac mechanical and electrical functions are dissociated, a phenomenon occurring in 25-42% of in-hospital cardiac arrest (IHCA) cases. Accurate evaluation of the likelihood of a PEA patient transitioning to return of spontaneous circulation (ROSC) may be vital for the successful resuscitation. The aim We sought to develop a model to automatically discriminate between PEA rhythms with favorable and unfavorable evolution to ROSC. Methods A dataset of 190 patients, 120 with ROSC, were acquired with defibrillators from different vendors in three hospitals. The ECG and the transthoracic impedance (TTI) signal were processed to compute 16 waveform features. Logistic regression models where designed integrating both automated features and characteristics annotated in the QRS to identify PEAs with better prognosis leading to ROSC. Cross validation techniques were applied, both patient-specific and stratified, to evaluate the performance of the algorithm. Results The best model consisted in a three feature algorithm that exhibited median (interquartile range) Area Under the Curve/Balanced accuracy/Sensitivity/Specificity of 80.3(9.9)/75.6(8.0)/ 77.4(15.2)/72.3(16.4) %, respectively. Conclusions Information hidden in the waveforms of the ECG and TTI signals, along with QRS complex features, can predict the progression of PEA. Automated methods as the one proposed in this study, could contribute to assist in the targeted treatment of PEA in IHCA.
Collapse
Affiliation(s)
- Jon Urteaga
- Communications Engineering Department, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo 1, 48013 Bilbao, Spain
| | - Andoni Elola
- Department of Electronic Technology, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo 1, 48013 Bilbao, Spain
| | - Anders Norvik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Eirik Unneland
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Trygve C. Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger (UiS), Kjell Arholms gate 41, 4021 Stavanger, Norway
| | - Abhishek Bhardwaj
- University of California, 900 University Ave, Riverside, CA 92521, United State
| | - David Buckler
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | | | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinas gate 3, 7030 Trondheim, Norway
| | - Elisabete Aramendi
- Communications Engineering Department, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo 1, 48013 Bilbao, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903 Barakaldo, Spain
| |
Collapse
|
3
|
Gentile FR, Wik L, Isasi I, Baldi E, Aramendi E, Steen-Hansen JE, Fasolino A, Compagnoni S, Contri E, Palo A, Primi R, Bendotti S, Currao A, Quilico F, Vicini Scajola L, Lopiano C, Savastano S. Amplitude spectral area of ventricular fibrillation and defibrillation success at low energy in out-of-hospital cardiac arrest. Intern Emerg Med 2023; 18:2397-2405. [PMID: 37556074 DOI: 10.1007/s11739-023-03386-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
The optimal energy for defibrillation has not yet been identified and very often the maximum energy is delivered. We sought to assess whether amplitude spectral area (AMSA) of ventricular fibrillation (VF) could predict low energy level defibrillation success in out-of-hospital cardiac arrest (OHCA) patients. This is a multicentre international study based on retrospective analysis of prospectively collected data. We included all OHCAs with at least one manual defibrillation. AMSA values were calculated by analyzing the data collected by the monitors/defibrillators used in the field (Corpuls 3 and Lifepak 12/15) and using a 2-s-pre-shock electrocardiogram interval. We run two different analyses dividing the shocks into three tertiles (T1, T2, T3) based on AMSA values. 629 OHCAs were included and 2095 shocks delivered (energy ranging from 100 to 360 J; median 200 J). Both in the "extremes analysis" and in the "by site analysis", the AMSA values of the effective shocks at low energy were significantly higher than those at high energy (p = 0.01). The likelihood of shock success increased significantly from the lowest to the highest tertile. After correction for age, call to shock time, use of mechanical CPR, presence of bystander CPR, sex and energy level, high AMSA value was directly associated with the probability of shock success [T2 vs T1 OR 3.8 (95% CI 2.5-6) p < 0.001; T3 vs T1 OR 12.7 (95% CI 8.2-19.2), p < 0.001]. AMSA values are associated with the probability of low-energy shock success so that they could guide energy optimization in shockable cardiac arrest patients.
Collapse
Affiliation(s)
- Francesca R Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Lars Wik
- Division of Prehospital Emergency Medicine, Oslo University Hospital, National Service of Competence for Prehospital Acute Medicine (NAKOS), Ullevål Hospital, Oslo, Norway
- Prehospital Clinic, Doctor car, Oslo University Hospital HF, Ullevål Hospital, Oslo, Norway
| | - Iraia Isasi
- BioRes Group, University of the Basque Country, Bilbao, Spain
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | | | | | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Enrico Contri
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
4
|
Raymond TT, Pandit SV, Griffis H, Zhang X, Hanna R, Niles DE, Silver A, Lasa JJ, Haskell SE, Atkins DL, Nadkarni VM. Effect of Amplitude Spectral Area on Termination of Fibrillation and Outcomes in Pediatric Cardiac Arrest. J Am Heart Assoc 2021; 10:e020353. [PMID: 34096341 PMCID: PMC8477851 DOI: 10.1161/jaha.120.020353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and survival in adults but has not been studied in pediatric cardiac arrest. We characterized AMSA during pediatric cardiac arrest from a Pediatric Resuscitation Quality Collaborative and hypothesized that AMSA would be associated with TOF and ROSC. Methods and Results Children aged <18 years with cardiac arrest and ventricular fibrillation were studied. AMSA was calculated for 2 seconds before shock and averaged for each subject (AMSA‐avg). TOF was defined as termination of ventricular fibrillation 10 seconds after defibrillation to any non‐ventricular fibrillation rhythm. ROSC was defined as >20 minutes without chest compressions. Univariate and multivariable logistic regression analyses controlling for weight, current, and illness category were performed. Primary end points were TOF and ROSC. Secondary end points were 24‐hour survival and survival to discharge. Between 2015 and 2019, 50 children from 14 hospitals with 111 shocks were identified. In univariate analyses AMSA was not associated with TOF and AMS‐Aavg was not associated with ROSC. Multivariable logistic regression showed no association between AMSA and TOF but controlling for defibrillation average current and illness category, there was a trend to significant association between AMSA‐avg and ROSC (odds ratio, 1.10 [1.00‒1.22] P=0.058). There was no significant association between AMSA‐avg and 24‐hour survival or survival to hospital discharge. Conclusions In pediatric patients, AMSA was not associated with TOF, whereas AMSA‐avg had a trend to significance for association in ROSC, but not 24‐hour survival or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.
Collapse
Affiliation(s)
- Tia T Raymond
- Division of Cardiac Critical Care Department of Pediatrics Medical City Children's Hospital Dallas TX
| | | | - Heather Griffis
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia PA
| | - Xuemei Zhang
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia PA
| | - Richard Hanna
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia PA
| | - Dana E Niles
- Department of Anesthesiology and Critical Care, and The Center for Simulation, Advanced Education, and Innovation The Children's Hospital of Philadelphia Philadelphia PA
| | | | - Javier J Lasa
- Sections of Cardiology and Critical Care Department of Pediatrics Texas Children's Hospital Houston TX
| | - Sarah E Haskell
- Division of Pediatric Cardiology Stead Family Department of Pediatrics University of Iowa Stead Family Children's Hospital Iowa City IA
| | - Dianne L Atkins
- Division of Pediatric Cardiology Stead Family Department of Pediatrics University of Iowa Stead Family Children's Hospital Iowa City IA
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, and The Center for Simulation, Advanced Education, and Innovation The Children's Hospital of Philadelphia Philadelphia PA.,Department of Anesthesiology, Critical Care, and Pediatrics The Children's Hospital of PhiladelphiaUniversity of Pennsylvania Philadelphia PA
| | | |
Collapse
|
5
|
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.
Collapse
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.
| | | |
Collapse
|
6
|
Chicote B, Aramendi E, Irusta U, Owens P, Daya M, Idris A. Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest. Resuscitation 2019; 138:74-81. [PMID: 30836170 PMCID: PMC6504568 DOI: 10.1016/j.resuscitation.2019.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIM Unsuccessful defibrillation shocks adversely affect survival from out-of-hospital cardiac arrest (OHCA). Ventricular fibrillation (VF) waveform analysis is the tool-of-choice for the non-invasive prediction of shock success, but surrogate markers of perfusion like end-tidal CO2 (EtCO2) could improve the prediction. The aim of this study was to evaluate EtCO2 as predictor of shock success, both individually and in combination with VF-waveform analysis. MATERIALS AND METHODS In total 514 shocks from 214 OHCA patients (75 first shocks) were analysed. For each shock three predictors of defibrillation success were automatically calculated from the device files: two VF-waveform features, amplitude spectrum area (AMSA) and fuzzy entropy (FuzzyEn), and the median EtCO2 (MEtCO2) in the minute before the shock. Sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated, for each predictor individually and for the combination of MEtCO2 and VF-waveform predictors. Separate analyses were done for first shocks and all shocks. RESULTS MEtCO2 in first shocks was significantly higher for successful than for unsuccessful shocks (31mmHg/25mmHg, p<0.05), but differences were not significant for all shocks (32mmHg/29mmHg, p>0.05). MEtCO2 predicted shock success with an AUC of 0.66 for first shocks, but was not a predictor for all shocks (AUC 0.54). AMSA and FuzzyEn presented AUCs of 0.76 and 0.77 for first shocks, and 0.75 and 0.75 for all shocks. For first shocks, adding MEtCO2 improved the AUC of AMSA and FuzzyEn to 0.79 and 0.83, respectively. CONCLUSIONS MEtCO2 predicted defibrillation success only for first shocks. Adding MEtCO2 to VF-waveform analysis in first shocks improved prediction of shock success. VF-waveform features and MEtCO2 were automatically calculated from the device files, so these methods could be introduced in current defibrillators adding only new software.
Collapse
Affiliation(s)
- Beatriz Chicote
- Communications Engineering Department, University of the Basque Country UPV/EHU, Ingeniero Torres Quevedo Plaza, 1, 48013 Bilbao, Spain.
| | - Elisabete Aramendi
- Communications Engineering Department, University of the Basque Country UPV/EHU, Ingeniero Torres Quevedo Plaza, 1, 48013 Bilbao, Spain
| | - Unai Irusta
- Communications Engineering Department, University of the Basque Country UPV/EHU, Ingeniero Torres Quevedo Plaza, 1, 48013 Bilbao, Spain
| | - Pamela Owens
- Department of Emergency Medicine, University of Texas Southwesterm Medical Center (UTSW), 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwesterm Medical Center (UTSW), 5323 Harry Hines Blvd, Dallas, TX, USA
| |
Collapse
|
7
|
Balderston JR, Gertz ZM, Ellenbogen KA, Schaaf KP, Ornato JP. Association between ventricular fibrillation amplitude immediately prior to defibrillation and defibrillation success in out-of-hospital cardiac arrest. Am Heart J 2018; 201:72-76. [PMID: 29910058 DOI: 10.1016/j.ahj.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Several characteristics of the ventricular fibrillation (VF) waveform during cardiac arrest are associated with defibrillation success, including peak amplitude in the seconds prior to defibrillation. It is not known if immediate pre-defibrillation amplitude is associated with successful defibrillation, return of spontaneous circulation (ROSC) or survival to hospital discharge (SHD). METHODS We analyzed automated external defibrillation recordings of 80 patients with out-of-hospital VF cardiac arrest who received 284 defibrillations. We recorded the maximum amplitude during 3-second ECG tracings prior to each defibrillation attempt and the amplitude immediately prior to defibrillation. RESULTS Both the amplitude just prior to defibrillation and the highest amplitude within 3 seconds of the defibrillation were significantly higher in successful vs unsuccessful defibrillations (0.21 vs 0.11 mV, P = <.0001 and 0.51 vs 0.36 mV, P = <.0001). Amplitude immediately prior to defibrillation and maximal amplitude within 3 seconds of defibrillation were also higher in defibrillations with ROSC vs. defibrillations without ROSC (0.23 vs. 0.12 mV, P < .0001; and 0.52 vs. 0.38 mV, P < .0001). In defibrillations that resulted in SHD, immediate pre-defibrillation amplitude and maximum amplitude were also significantly larger (0.20 vs. 0.11 mV, P < .0001; and 0.52 vs. 0.35 mV, P < .0001). Binary logistic regression including both measures showed that only immediate pre-defibrillation amplitude remained significantly associated with ROSC while maximal amplitude did not (P = .006 and P = .135). CONCLUSIONS Amplitude of the VF waveform at the moment of defibrillation has a strong association with successful defibrillation, ROSC, and SHD.
Collapse
|
8
|
Segal N, Metzger AK, Moore JC, India L, Lick MC, Berger PS, Tang W, Benditt DG, Lurie KG. Correlation of end tidal carbon dioxide, amplitude spectrum area, and coronary perfusion pressure in a porcine model of cardiac arrest. Physiol Rep 2018; 5:5/17/e13401. [PMID: 28899911 PMCID: PMC5599861 DOI: 10.14814/phy2.13401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/06/2017] [Indexed: 11/24/2022] Open
Abstract
Amplitude Spectrum Area (AMSA) values during ventricular fibrillation (VF) correlate with myocardial energy stores and predict defibrillation success. By contrast, end tidal CO2 (ETCO2) values provide a noninvasive assessment of coronary perfusion pressure and myocardial perfusion during cardiopulmonary resuscitation (CPR). Given the importance of the timing of defibrillation shock delivery on clinical outcome, we tested the hypothesis that AMSA and ETCO2 correlate with each other and can be used interchangably to correlate with myocardial perfusion in an animal laboratory preclinical, randomized, prospective investigation. After 6 min of untreated VF, 12 female pigs (32 ± 1 Kg), isoflurane anesthetized pigs received sequentially 3 min periods of standard (S) CPR, S‐CPR+ an impedance threshold device (ITD), and then active compression decompression (ACD) + ITD CPR. Hemodynamic, AMSA, and ETCO2 measurements were made with each method of CPR. The Spearman correlation and Friedman tests were used to compare hemodynamic parameters. ETCO2, AMSA, coronary perfusion pressure, cerebral perfusion pressure were lowest with STD CPR, increased with STD CPR + ITD and highest with ACD CPR + ITD. Further analysis demonstrated a positive correlation between AMSA and ETCO2 (r = 0.37, P = 0.025) and between AMSA and key hemodynamic parameters (P < 0.05). This study established a moderate positive correlation between ETCO2 and AMSA. These findings provide the physiological basis for developing and testing a novel noninvasive method that utilizes either ETCO2 alone or the combination of ETCO2 and AMSA to predict when defibrillation might be successful.
Collapse
Affiliation(s)
- Nicolas Segal
- Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Johanna C Moore
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Laura India
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michael C Lick
- Minnesota Medical Research Foundation, Minneapolis, Minnesota
| | | | - Wanchun Tang
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - David G Benditt
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Keith G Lurie
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
9
|
Alonso E, Aramendi E, Irusta U, Daya M, Corcuera C, Lu Y, Idris AH. Evaluation of chest compression artefact removal based on rhythm assessments made by clinicians. Resuscitation 2018; 125:104-110. [DOI: 10.1016/j.resuscitation.2018.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
|
10
|
Jin D, Dai C, Gong Y, Lu Y, Zhang L, Quan W, Li Y. Does the choice of definition for defibrillation and CPR success impact the predictability of ventricular fibrillation waveform analysis? Resuscitation 2016; 111:48-54. [PMID: 27951401 DOI: 10.1016/j.resuscitation.2016.11.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Quantitative analysis of ventricular fibrillation (VF), such as amplitude spectral area (AMSA), predicts shock outcomes. However, there is no uniform definition of shock/cardiopulmonary resuscitation (CPR) success in out-of-hospital cardiac arrest (OHCA). The objective of this study is to investigate post-shock rhythm variations and the impact of shock/CPR success definition on the predictability of AMSA. METHODS A total of 554 shocks from 257 OHCA patients with VF as initial rhythm were analyzed. Post-shock rhythms were analyzed every 5s up to 120s and annotated as VF, asystole (AS) and organized rhythm (OR) at serial time intervals. Three shock/CPR success definitions were used to evaluate the predictability of AMSA: (1) termination of VF (ToVF); (2) return of organized electrical activity (ROEA); (3) return of potentially perfusing rhythm (RPPR). RESULTS Rhythm changes occurred after 54.5% (N=302) of shocks and 85.8% (N=259) of them occurred within 60s after shock delivery. The observed post-shock rhythm changes were (1) from AS to VF (24.9%), (2) from OR to VF (16.1%), and (3) from AS to OR (12.1%). The area under the receiver operating characteristic curve (AUC) for AMSA as a predictor of shock/CPR success reached its maximum 60s post-shock. The AUC was 0.646 for ToVF, 0.782 for ROEA, and 0.835 for RPPR (p<0.001) respectively. CONCLUSIONS Post-shock rhythm is unstable in the first minute after the shock. The predictability of AMSA varies depending on the definition of shock/CPR success and performs best with the return of potentially perfusing rhythm endpoint for OHCA.
Collapse
Affiliation(s)
- Danian Jin
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China; Information Department, The 303th Hospital of PLA, Nanning, Guangxi 530021, China
| | - Chenxi Dai
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yushun Gong
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
| | - Yubao Lu
- Emergency Department, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Lei Zhang
- Emergency Department, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Weilun Quan
- ZOLL Medical Corporation, Chelmsford, MA 01824, USA
| | - Yongqin Li
- School of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China.
| |
Collapse
|
11
|
Shandilya S, Kurz MC, Ward KR, Najarian K. Integration of Attributes from Non-Linear Characterization of Cardiovascular Time-Series for Prediction of Defibrillation Outcomes. PLoS One 2016; 11:e0141313. [PMID: 26741805 PMCID: PMC4704775 DOI: 10.1371/journal.pone.0141313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/07/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The timing of defibrillation is mostly at arbitrary intervals during cardio-pulmonary resuscitation (CPR), rather than during intervals when the out-of-hospital cardiac arrest (OOH-CA) patient is physiologically primed for successful countershock. Interruptions to CPR may negatively impact defibrillation success. Multiple defibrillations can be associated with decreased post-resuscitation myocardial function. We hypothesize that a more complete picture of the cardiovascular system can be gained through non-linear dynamics and integration of multiple physiologic measures from biomedical signals. Materials and Methods Retrospective analysis of 153 anonymized OOH-CA patients who received at least one defibrillation for ventricular fibrillation (VF) was undertaken. A machine learning model, termed Multiple Domain Integrative (MDI) model, was developed to predict defibrillation success. We explore the rationale for non-linear dynamics and statistically validate heuristics involved in feature extraction for model development. Performance of MDI is then compared to the amplitude spectrum area (AMSA) technique. Results 358 defibrillations were evaluated (218 unsuccessful and 140 successful). Non-linear properties (Lyapunov exponent > 0) of the ECG signals indicate a chaotic nature and validate the use of novel non-linear dynamic methods for feature extraction. Classification using MDI yielded ROC-AUC of 83.2% and accuracy of 78.8%, for the model built with ECG data only. Utilizing 10-fold cross-validation, at 80% specificity level, MDI (74% sensitivity) outperformed AMSA (53.6% sensitivity). At 90% specificity level, MDI had 68.4% sensitivity while AMSA had 43.3% sensitivity. Integrating available end-tidal carbon dioxide features into MDI, for the available 48 defibrillations, boosted ROC-AUC to 93.8% and accuracy to 83.3% at 80% sensitivity. Conclusion At clinically relevant sensitivity thresholds, the MDI provides improved performance as compared to AMSA, yielding fewer unsuccessful defibrillations. Addition of partial end-tidal carbon dioxide (PetCO2) signal improves accuracy and sensitivity of the MDI prediction model.
Collapse
Affiliation(s)
- Sharad Shandilya
- Virginia Commonwealth University, Richmond, Virginia, United States of America
- * E-mail:
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama, United States of America
| | - Kevin R. Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- Michigan Center for Integrative Research in Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| |
Collapse
|
12
|
Predict Defibrillation Outcome Using Stepping Increment of Poincare Plot for Out-of-Hospital Ventricular Fibrillation Cardiac Arrest. BIOMED RESEARCH INTERNATIONAL 2015; 2015:493472. [PMID: 26413527 PMCID: PMC4572405 DOI: 10.1155/2015/493472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 11/17/2022]
Abstract
Early cardiopulmonary resuscitation together with early defibrillation is a key point in the chain of survival for cardiac arrest. Optimizing the timing of defibrillation by predicting the possibility of successful electric shock can guide treatments between defibrillation and cardiopulmonary resuscitation and improve the rate of restoration of spontaneous circulation. Numerous methods have been proposed for predicting defibrillation success based on quantification of the ventricular fibrillation waveform during past decades. To date, however, no analytical technique has been widely accepted for clinical application. In the present study, we investigate whether median stepping increment that is calculated from the Euclidean distance of consecutive points in Poincare plot could be used to predict the likelihood of successful defibrillation. Electrocardiographic recordings of out-of-hospital cardiac arrest patients were obtained from the external defibrillators. The performance of the proposed method was evaluated by receiver operating characteristic curve and compared with the results of other established features. The results indicated that median stepping increment has comparable performance to the established methods in predicting the likelihood of successful defibrillation.
Collapse
|
13
|
Rasooli M, Foomany F, Balasundaram K, Masse S, Zamiri N, Ramadeen A, Hu X, Dorian P, Nanthakumar K, Krishnan S, Beheshti S, Umapathy K. Analysis of electrocardiogram pre-shock waveforms during ventricular fibrillation. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
14
|
Amplitude-spectral area and chest compression release velocity independently predict hospital discharge and good neurological outcome in ventricular fibrillation out-of-hospital cardiac arrest. Resuscitation 2015; 92:122-8. [DOI: 10.1016/j.resuscitation.2015.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/25/2015] [Accepted: 05/04/2015] [Indexed: 11/18/2022]
|
15
|
Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study. BMC Cardiovasc Disord 2014; 14:199. [PMID: 25528598 PMCID: PMC4289585 DOI: 10.1186/1471-2261-14-199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
Background In current guidelines, prolonged cardiopulmonary resuscitation (CPR) mandates administration of repeated intravenous epinephrine (EPI) doses. This porcine study simulating a prolonged CPR-situation in the coronary catheterisation laboratory, explores the effect of EPI-administrations on coronary perfusion pressure (CPP), continuous coronary artery flow average peak velocity (APV) and amplitude spectrum area (AMSA). Methods Thirty-six pigs were randomized 1:1:1 to EPI 0.02 mg/kg/dose, EPI 0.03 mg/kg/dose or saline (control) in an experimental cardiac arrest (CA) model. During 15 minutes of mechanical chest compressions, four EPI/saline-injections were administered, and the effect on CPP, APV and AMSA were recorded. Comparisons were performed between the control and the two EPI-groups and a combination of the two EPI-groups, EPI-all. Result Compared to the control group, maximum peak of CPP (Pmax) after injection 1 and 2 was significantly increased in the EPI-all group (p = 0.022, p = 0.016), in EPI 0.02-group after injection 2 and 3 (p = 0.023, p = 0.027) and in EPI 0.03-group after injection 1 (p = 0.013). At Pmax, APV increased only after first injection in both the EPI-all and the EPI 0.03-group compared with the control group (p = 0.011, p = 0.018). There was no statistical difference of AMSA at any Pmax. Seven out of 12 animals (58%) in each EPI-group versus 10 out of 12 (83%) achieved spontaneous circulation after CA. Conclusion In an experimental CA-CPR pig model repeated doses of intravenous EPI results in a significant increase in APV only after the first injection despite increments in CPP also during the following 2 injections indicating inappropriate changes in coronary vascular resistance during subsequent EPI administration.
Collapse
|
16
|
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.
Collapse
|
17
|
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: 43] [Impact Index Per Article: 4.3] [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.
Collapse
|
18
|
Noordergraaf GJ, Noordergraaf A. What should determine loop time during CPR: A generic algorithm or the patient's initial rhythm? Resuscitation 2014; 85:9-10. [DOI: 10.1016/j.resuscitation.2013.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
|
19
|
Ristagno G, Fumagalli F. Amplitude Spectrum Area to Predict the Success of Defibrillation. Resuscitation 2014. [DOI: 10.1007/978-88-470-5507-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Translational Research: An Ongoing Challenge in Cardiac Arrest. Resuscitation 2014. [DOI: 10.1007/978-88-470-5507-0_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
21
|
The Importance of Automated External Defibrillation Implementation Programs. Resuscitation 2014. [DOI: 10.1007/978-88-470-5507-0_7] [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]
|
22
|
Amplitude spectrum area to guide resuscitation—A retrospective analysis during out-of-hospital cardiopulmonary resuscitation in 609 patients with ventricular fibrillation cardiac arrest. Resuscitation 2013; 84:1697-703. [DOI: 10.1016/j.resuscitation.2013.08.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 08/20/2013] [Indexed: 11/18/2022]
|
23
|
Deakin CD. À la carte defibrillation poised to enter the fixed price resuscitation menu. Resuscitation 2013; 84:1639-40. [PMID: 24096011 DOI: 10.1016/j.resuscitation.2013.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 09/24/2013] [Indexed: 01/21/2023]
Affiliation(s)
- Charles D Deakin
- University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
| |
Collapse
|
24
|
Wu X, Bisera J, Tang W. Signal integral for optimizing the timing of defibrillation. Resuscitation 2013; 84:1704-7. [PMID: 23969193 DOI: 10.1016/j.resuscitation.2013.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The possibility of successful defibrillation decreases with an increased duration of ventricular fibrillation (VF). Futile electrical shocks are inversely correlated with myocardial contractile function and long-term survival. Previous studies have demonstrated that various ECG waveform analyses predict the success of defibrillation. This study investigated whether the absolute amplitude of pre-shock VF waveform is likely to predict the success of defibrillation. METHODS ECG recordings of 350 out-of-hospital cardiac arrest (OOHCA) patients were obtained from the automated external defibrillator (AED) and analyzed by the method of signal integral. Successful defibrillation was defined as organized rhythm with heart rate ≥40beat/min commencing within one min of post-shock period and persisting for a minimum of 30s. RESULTS Signal integral was significantly greater in successful defibrillation than unsuccessful defibrillation (81.76±32.3mV vs. 34.9±15.33mV, p<0.001). The intersection of the sensitivity and specificity curve provided a threshold value of 51mV. The corresponding values of sensitivity, specificity, positive predictive and negative predictive values for successful defibrillation were 90%, 86%, 80% and 93%, respectively. The receiver operator curve further revealed that signal integral predicted the likelihood of successful defibrillation (area under the curve=0.949). CONCLUSIONS Signal integral predicted successful electrical shocks on patients with ventricular fibrillation and have potential to optimize the timing of defibrillation and reduce the number of electrical shocks.
Collapse
Affiliation(s)
- Xiaobo Wu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | | | | |
Collapse
|
25
|
Kurz MC, Sawyer KN. Perhaps crying “clear” should be left to the TV actors? Resuscitation 2013; 84:533-4. [DOI: 10.1016/j.resuscitation.2013.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
|
26
|
Shandilya S, Ward K, Kurz M, Najarian K. Non-linear dynamical signal characterization for prediction of defibrillation success through machine learning. BMC Med Inform Decis Mak 2012; 12:116. [PMID: 23066818 PMCID: PMC3502402 DOI: 10.1186/1472-6947-12-116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/22/2012] [Indexed: 11/20/2022] Open
Abstract
Background Ventricular Fibrillation (VF) is a common presenting dysrhythmia in the setting of cardiac arrest whose main treatment is defibrillation through direct current countershock to achieve return of spontaneous circulation. However, often defibrillation is unsuccessful and may even lead to the transition of VF to more nefarious rhythms such as asystole or pulseless electrical activity. Multiple methods have been proposed for predicting defibrillation success based on examination of the VF waveform. To date, however, no analytical technique has been widely accepted. We developed a unique approach of computational VF waveform analysis, with and without addition of the signal of end-tidal carbon dioxide (PetCO2), using advanced machine learning algorithms. We compare these results with those obtained using the Amplitude Spectral Area (AMSA) technique. Methods A total of 90 pre-countershock ECG signals were analyzed form an accessible preshosptial cardiac arrest database. A unified predictive model, based on signal processing and machine learning, was developed with time-series and dual-tree complex wavelet transform features. Upon selection of correlated variables, a parametrically optimized support vector machine (SVM) model was trained for predicting outcomes on the test sets. Training and testing was performed with nested 10-fold cross validation and 6–10 features for each test fold. Results The integrative model performs real-time, short-term (7.8 second) analysis of the Electrocardiogram (ECG). For a total of 90 signals, 34 successful and 56 unsuccessful defibrillations were classified with an average Accuracy and Receiver Operator Characteristic (ROC) Area Under the Curve (AUC) of 82.2% and 85%, respectively. Incorporation of the end-tidal carbon dioxide signal boosted Accuracy and ROC AUC to 83.3% and 93.8%, respectively, for a smaller dataset containing 48 signals. VF analysis using AMSA resulted in accuracy and ROC AUC of 64.6% and 60.9%, respectively. Conclusion We report the development and first-use of a nontraditional non-linear method of analyzing the VF ECG signal, yielding high predictive accuracies of defibrillation success. Furthermore, incorporation of features from the PetCO2 signal noticeably increased model robustness. These predictive capabilities should further improve with the availability of a larger database.
Collapse
Affiliation(s)
- Sharad Shandilya
- Department of Computer Science, Virginia Commonwealth University, VCU Reanimation Engineering Science Center, 1818 Providence Creek Cir, Richmond, VA 23236, USA.
| | | | | | | |
Collapse
|
27
|
Shanmugasundaram M, Valles A, Kellum MJ, Ewy GA, Indik JH. Analysis of amplitude spectral area and slope to predict defibrillation in out of hospital cardiac arrest due to ventricular fibrillation (VF) according to VF type: Recurrent versus shock-resistant. Resuscitation 2012; 83:1242-7. [DOI: 10.1016/j.resuscitation.2012.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/31/2012] [Accepted: 02/06/2012] [Indexed: 11/24/2022]
|
28
|
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.
Collapse
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.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
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
| |
Collapse
|
30
|
Barash DM, Raymond RP, Tan Q, Silver AE. A New Defibrillator Mode to Reduce Chest Compression Interruptions for Health Care Professionals and Lay Rescuers: A Pilot Study in Manikins. PREHOSP EMERG CARE 2011; 15:88-97. [DOI: 10.3109/10903127.2010.531375] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
Predictors of resuscitation in a swine model of ischemic and nonischemic ventricular fibrillation cardiac arrest: superiority of amplitude spectral area and slope to predict a return of spontaneous circulation when resuscitation efforts are prolonged. Crit Care Med 2010; 38:2352-7. [PMID: 20890198 DOI: 10.1097/ccm.0b013e3181fa01ee] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We have demonstrated that a return of spontaneous circulation in the first 3 mins of resuscitation in swine is predicted by ventricular fibrillation waveform (amplitude spectral area or slope) when untreated ventricular fibrillation duration or presence of acute myocardial infarction is unknown. We hypothesized that in prolonged resuscitation efforts that return of spontaneous circulation immediately after a second or later shock with postshock chest compression is independently predicted by end-tidal CO2, coronary perfusion pressure, and ventricular fibrillation waveform measured before that shock in a swine model of ischemic and nonischemic ventricular fibrillation arrest. DESIGN Animal intervention study with comparison to a control group. SETTING University animal laboratory. SUBJECTS Twenty swine. INTERVENTIONS Myocardial infarction was induced by steel plug occlusion of the left anterior descending coronary artery. Ventricular fibrillation was untreated for 8 mins in normal swine (n=10) and acute myocardial infarction swine (n=10). MEASUREMENTS AND MAIN RESULTS End-tidal CO2, coronary perfusion pressure, and ventricular fibrillation waveform characteristics of amplitude spectral area and slope were analyzed before second or later shocks. For an amplitude spectral area>35 mV-Hz, the odds ratio for achieving return of spontaneous circulation after that shock was 72 (95% confidence interval, 3.8-1300; p=.004) compared with an amplitude spectral area<28 mV-Hz and with an area under the receiver operator characteristic curve of 0.86. For slope>3.6 mV/s, the odds ratio for achieving return of spontaneous circulation was 36 (95% confidence interval, 2.7-480; p=.007) compared with slope<2.72 mV/s with an area under the curve of 0.86. End-tidal CO2 and coronary perfusion pressure were not predictive of return of spontaneous circulation after a shock, although coronary perfusion pressure was significantly related to both amplitude spectral area (p<.001) and slope (p<.001). CONCLUSIONS : In prolonged untreated ventricular fibrillation arrest, the waveform characteristics of amplitude spectral area and slope predict the attainment of return of spontaneous circulation with a second or later shock. This has implications for the ideal means to customize the timing of shocks and chest compressions when return of spontaneous circulation is not promptly obtained.
Collapse
|
32
|
Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S729-67. [PMID: 20956224 DOI: 10.1161/circulationaha.110.970988] [Citation(s) in RCA: 888] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.
Collapse
|
33
|
|