Course of quantitative ventricular fibrillation waveform measure and outcome following out-of-hospital cardiac arrest.
BACKGROUND
Quantitative measures of the ventricular fibrillation waveform at the outset of resuscitation are associated with survival. However, little is known about the course of these measures during resuscitation and how this course is related to outcome.


OBJECTIVE
The purpose of this study was to determine how waveform measures change over the course of resuscitation and whether these changes might be used to guide resuscitation.


METHODS
We evaluated 390 persons treated by emergency providers following out-of-hospital ventricular fibrillation arrest. We assessed the ventricular fibrillation waveform using the amplitude spectrum area (AMSA) from the defibrillator's continuous electrocardiogram measured before each of the first three shocks. We used logistic regression to evaluate the relationship of AMSA and the change in AMSA with favorable neurologic survival as determined by the Cerebral Performance Category at hospital discharge 1-2.


RESULTS
Of the 390 patients who received an initial shock, 273 required a second shock and 210 required a third shock. The mean (standard deviation) for AMSA was 9.64 (0.52) for the 873 total shock cycles. AMSA₁ measured before the first shock was strongly associated with favorable neurologic survival (odds ratio [OR] 3.40, 95% confidence interval [CI] [2.48, 4.66] for 1 SD change). We observed a similar relationship for second-shock AMSA₂ (OR 3.53, 95% CI [2.42, 5.14]) and third-shock AMSA₃ (OR 3.10, 95% CI [2.03, 4.73]). The median change in AMSA was 0.24 for ΔAMSA₁₋₂ and 0.21 for ΔAMSA₂₋₃. A positive median change in AMSA between shocks was associated with favorable neurologic survival (OR 1.44, 95% CI [1.16, 1.80] for ΔAMSA₁₋₂ and OR 1.31, 95% CI [1.01, 1.71] for ΔAMSA₂₋₃).


CONCLUSION
Given their prognostic and dynamic qualities, quantitative waveform measures may provide an effective real-time strategy to guide individual treatment and improve survival.
['Schoene|Peter|P|', 'Coult|Jason|J|', 'Murphy|Lauren|L|', 'Fahrenbruch|Carol|C|', 'Blackwood|Jennifer|J|', 'Kudenchuk|Peter|P|', 'Sherman|Lawrence|L|', 'Rea|Thomas|T|']
D016887:Cardiopulmonary Resuscitation D004562:Electrocardiography D005260:Female D006801:Humans D016015:Logistic Models D008297:Male D008875:Middle Aged D058687:Out-of-Hospital Cardiac Arrest D011379:Prognosis D012189:Retrospective Studies D014693:Ventricular Fibrillation
Ventricular fibrillation Waveform Cardiac arrest Resuscitation amplitude spectrum area AMSA Electrocardiogram Electrocardiogram odds ratio OR confidence interval CI CPR Cardiopulmonary resuscitation ECG EMS Signal processing cardiopulmonary resuscitation electrocardiogram emergency medical services