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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 Sep 30; 64(13):1362-9.JACC

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.

Authors+Show Affiliations

Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona. Electronic address: jindik@email.arizona.edu.Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona.Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona.ZOLL Medical, Chelmsford, Massachusetts.Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.Department of Emergency Medicine, Maricopa Medical Center, University of Arizona College of Medicine, Phoenix, Arizona.Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25257639

Citation

Indik, Julia H., et al. "Association of Amplitude Spectral Area of the Ventricular Fibrillation Waveform With Survival of Out-of-hospital Ventricular Fibrillation Cardiac Arrest." Journal of the American College of Cardiology, vol. 64, no. 13, 2014, pp. 1362-9.
Indik JH, Conover Z, McGovern M, et al. 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(13):1362-9.
Indik, J. H., Conover, Z., McGovern, M., Silver, A. E., Spaite, D. W., Bobrow, B. J., & Kern, K. B. (2014). Association of amplitude spectral area of the ventricular fibrillation waveform with survival of out-of-hospital ventricular fibrillation cardiac arrest. Journal of the American College of Cardiology, 64(13), 1362-9. https://doi.org/10.1016/j.jacc.2014.06.1196
Indik JH, et al. 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 Sep 30;64(13):1362-9. PubMed PMID: 25257639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of amplitude spectral area of the ventricular fibrillation waveform with survival of out-of-hospital ventricular fibrillation cardiac arrest. AU - Indik,Julia H, AU - Conover,Zacherie, AU - McGovern,Meghan, AU - Silver,Annemarie E, AU - Spaite,Daniel W, AU - Bobrow,Bentley J, AU - Kern,Karl B, PY - 2014/01/12/received PY - 2014/05/29/revised PY - 2014/06/03/accepted PY - 2014/9/27/entrez PY - 2014/9/27/pubmed PY - 2014/11/18/medline KW - cardiopulmonary resuscitation KW - heart arrest KW - ventricular fibrillation SP - 1362 EP - 9 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 64 IS - 13 N2 - 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/25257639/Association_of_amplitude_spectral_area_of_the_ventricular_fibrillation_waveform_with_survival_of_out_of_hospital_ventricular_fibrillation_cardiac_arrest_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(14)05629-0 DB - PRIME DP - Unbound Medicine ER -