title: Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest.
abstract: Survival of cardiac arrest is improved by basic life support (BLS). This study investigated the relationship between ventricular fibrillation (VF) characteristics and survival. In a 2-year prospective study out-of-hospital witnessed non-traumatic cardiac arrests were observed. The probabilities of recording VF, asystole or other rhythms in relation to BLS and the time to the rhythm recording were analyzed with logistic regression. Amplitude and baseline crossings of VF were related to survival, using linear regression analysis. In 873 patients, the probability to record VF decreased per minute (OR 0.92, 95%CI 0.89-0.95) and of asystole increased (OR 1.13, 95%CI 1.09-1.18) as time from collapse elapsed. BLS reduced these trends significantly for VF (OR 0.97, 95%CI 0.94-0.99) and asystole (OR 1.09, 95%CI 1.05-1.13). This effect was not observed for other rhythms. The amplitude of VF decreased in time; significantly less for patients who received BLS than for those who did not (p=0.009). Survival significantly decreased with lower amplitude of VF (OR 0.23 per mV, 95%CI 0.07-0.79) and with less baseline crossings (OR 0.80 per baseline crossings per second, 95%CI 0.71-0.91). Our study demonstrated that BLS and VF as initial rhythm, considered being "baseline" predictors in survival models, were proved not independent of each other. The decrease of VF amplitude and increase in prevalence of asystole is slowed significantly by BLS. Predicting survival from VF amplitude and baseline crossings alone is limited.
authors.affiliation: Academic Medical Center, Department of Cardiology, University of Amsterdam, F4-143, PO Box 22700, 1100 DE Amsterdam, The Netherlands. r.a.waalewijn@amc.uva.nl
authors.forename: Reinier A
authors.initials: RA
authors.lastname: Waalewijn
authors.forename: Marië A
authors.initials: MA
authors.lastname: Nijpels
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
mesh_terms: D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D006323:Heart Arrest / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D009426:Netherlands; D016019:Survival Analysis; D014693:Ventricular Fibrillation / Q000628:therapy*