Salvatore Aiello , MS 1 , Michelle Perez , BA 1 , Chad Cogan , BA 1 , Alvin Baetiong , MS 2 , Steven A. Miller , PhD 1 , Jeejabai Radhakrishnan , PhD 2 , Christopher L. Kaufman , PhD 3 , Raúl J. Gazmuri , MD, PhD, FCCM , 2 , 4
04 November 2017
amplitude spectral area, animal model, defibrillation, resuscitation, sudden cardiac arrest, ventricular fibrillation, ventricular fibrillation waveform analysis, waveform analysis, Cardiopulmonary Resuscitation and Emergency Cardiac Care, Sudden Cardiac Death, Ventricular Fibrillation, Animal Models of Human Disease, Translational Studies
The ventricular fibrillation amplitude spectral area (AMSA) predicts whether an electrical shock could terminate ventricular fibrillation and prompt return of spontaneous circulation. We hypothesized that AMSA can guide more precise timing for effective shock delivery during cardiopulmonary resuscitation.
Three shock delivery protocols were compared in 12 pigs each after electrically induced ventricular fibrillation, with the duration of untreated ventricular fibrillation evenly stratified into 6, 9, and 12 minutes: AMSA‐Driven (AD), guided by an AMSA algorithm; Guidelines‐Driven (GD), according to cardiopulmonary resuscitation guidelines; and Guidelines‐Driven/AMSA‐Enabled (GDAE), as per GD but allowing earlier shocks upon exceeding an AMSA threshold. Shocks delivered using the AD, GD, and GDAE protocols were 21, 40, and 62, with GDAE delivering only 2 AMSA‐enabled shocks. The corresponding 240‐minute survival was 8/12, 6/12, and 2/12 (log‐rank test, P=0.035) with AD exceeding GDAE ( P=0.026). The time to first shock (seconds) was (median [Q1–Q3]) 272 (161–356), 124 (124–125), and 125 (124–125) ( P<0.001) with AD exceeding GD and GDAE ( P<0.05); the average coronary perfusion pressure before first shock (mm Hg) was 16 (9–30), 10 (6–12), and 3 (−1 to 9) ( P=0.002) with AD exceeding GDAE ( P<0.05); and AMSA preceding the first shock (mV·Hz, mean±SD) was 13.3±2.2, 9.0±1.6, and 8.6±2.0 ( P<0.001) with AD exceeding GD and GDAE ( P<0.001). The AD protocol delivered fewer unsuccessful shocks (ie, less shock burden) yielding less postresuscitation myocardial dysfunction and higher 240‐minute survival.