Author(s): Young C, Bisera J, Gehman S, Snyder D, Tang W,
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Abstract OBJECTIVE: The objective of our study was to examine the effectiveness of an electrocardiographic predictor, amplitude spectral area (AMSA), for the optimal timing of defibrillation shocks in human victims of cardiac arrest. Based on the spectral characteristics of ventricular fibrillation potentials, we examined the probability of successful conversion to an organized viable rhythm, including the return of spontaneous circulation. The incentive was to predict the likelihood of successful defibrillation and thereby improve outcomes by minimizing interruptions in chest compression and minimizing electrically induced myocardial injury due to repetitive high-current shocks. DESIGN: Observational study on human electrocardiographic recordings during cardiopulmonary resuscitation. SETTING: Medical research laboratory of a university-affiliated research and educational institute. PATIENTS: Victims of out-of-hospital cardiac arrest. INTERVENTIONS: Iteration of electrocardiographic records, representing lead 2 equivalent recordings on 108 defibrillation attempts with an automated external defibrillator, of 46 victims of cardiac arrest due to ventricular fibrillation. MEASUREMENTS AND MAIN RESULTS: Three seconds of ventricular fibrillation, recorded immediately preceding delivery of a shock, were analyzed utilizing the AMSA algorithm. AMSA represents a numerical value based on the sum of the magnitude of the weighted frequency spectrum between 3 and 48 Hz. The greater the AMSA value, the greater was the probability of reversal of ventricular fibrillation. At an AMSA value of >13.0 mV-Hz, successful defibrillation yielded a sensitivity of .91 and a specificity of .94. CONCLUSION: AMSA predicts the success of electrical defibrillation with high specificity. AMSA therefore serves to minimize interruptions of precordial compression and the myocardial damage caused by delivery of repetitive and ineffective electrical shocks.
This article was published in Crit Care Med
and referenced in Journal of Clinical & Experimental Cardiology