Analysing ventricular fibrillation ECG-signals and predicting defibrillation success during cardiopulmonary resuscitation employing N(alpha)-histograms.
Mean fibrillation frequency may predict defibrillation success during cardiopulmonary resuscitation (CPR). N(alpha)-histogram analysis should be investigated as an alternative. After 4 min of cardiac arrest, and 3 versus 8 min of CPR, 25 pigs received either vasopressin or epinephrine (0.4, 0.4, and 0.8 U/kg vasopressin versus 45, 45, and 200 microg/kg epinephrine) every 5 min with defibrillation at 22 min. Before defibrillation, the N(alpha)-parameter histogramstart/histogramwidth and the mean fibrillation frequency in resuscitated versus non-resuscitated pigs were 2.9+/-0.4 versus 1.7+/-0.5 (P=0.0000005); and 9.5+/-1.7 versus 6.9+/-0.7 (P=0.0003). During the last minute prior to defibrillation, histogramstart/histogramwidth of > or =2.3 versus mean fibrillation frequency > or =8 Hz predicted successful defibrillation with subsequent return of a spontaneous circulation for more than 60 min with sensitivity, specificity, positive predictive value and negative predictive value of 94 versus 82%, 96 versus 89%, 98 versus 93% and 90 versus 74%, respectively. We conclude, that N(alpha)-analysis was superior to mean fibrillation frequency analysis during CPR in predicting defibrillation success, and distinction between vasopressin versus epinephrine effects.
Amann
A
A
Department of Anesthesiology and Critical Care, The Leopold-Franzens University, Anichstrasse 35, 6020, Innsbruck, Austria
Achleitner
U
U
Antretter
H
H
Bonatti
J O
JO
Krismer
A C
AC
Lindner
K H
KH
Rieder
J
J
Wenzel
V
V
Voelckel
W G
WG
Strohmenger
H U
HU
D000465:Algorithms; D000704:Analysis of Variance; D000818:Animals; D016887:Cardiopulmonary Resuscitation; D004195:Disease Models, Animal; D004554:Electric Countershock; D004562:Electrocardiography; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005583:Fourier Analysis; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013057:Spectrum Analysis; D013552:Swine; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use; D014693:Ventricular Fibrillation / Q000503:physiopathology* / Q000628:therapy*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine