title: The impedance cardiogram recorded through two electrocardiogram/defibrillator pads as a determinant of cardiac arrest during experimental studies.
abstract: OBJECTIVE
  Laypersons are poor at emergency pulse checks (sensitivity 84%, specificity 36%). Guidelines indicate that pulse checks should not be performed. The impedance cardiogram (dZ/dt) is used to assess stroke volume. Can a novel defibrillator-based impedance cardiogram system be used to distinguish between circulatory arrest and other collapse states?
  
  
  METHODS
  Animal study.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Twenty anesthetized, mechanically ventilated pigs, weight 50-55 kg.
  
  
  METHODS
  Stroke volume was altered by right ventricular pacing (160, 210, 260, and 305 beats/min). Cardiac arrest states were then induced: ventricular fibrillation (by rapid ventricular pacing) and, after successful defibrillation, pulseless electrical activity and asystole (by high-dose intravenous pentobarbitone).
  
  
  RESULTS
  The impedance cardiogram was recorded through electrocardiogram/defibrillator pads in standard cardiac arrest positions. Simultaneously recorded electro- and impedance cardiogram (dZ/dt) along with arterial blood pressure tracings were digitized during each pacing and cardiac arrest protocol. Five-second epochs were analyzed for sinus rhythm (20 before ventricular fibrillation, 20 after successful defibrillation), ventricular fibrillation (40), pulseless electrical activity (20), and asystole (20), in two sets of ten pigs (ten training, ten validation). Standard impedance cardiogram variables were noncontributory in cardiac arrest, so the fast Fourier transform of dZ/dt was assessed. During ventricular pacing, the peak amplitude of fast Fourier transform of dZ/dt (between 1.5 and 4.5 Hz) correlated with stroke volume (r2 = .3, p < .001). In cardiac arrest, a peak amplitude of fast Fourier transform of dZ/dt of < or = 4 dB x ohm x rms indicated no output with high sensitivity (94% training set, 86% validation set) and specificity (98% training set, 90% validation set).
  
  
  CONCLUSIONS
  As a powerful clinical marker of circulatory collapse, the fast Fourier transformation of dZ/dt (impedance cardiogram) has the potential to improve emergency care by laypersons using automated defibrillators.
authors.affiliation: Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland. nacromie@doctors.org.uk
authors.forename: Nick Alexander
authors.initials: NA
authors.lastname: Cromie
authors.forename: John Desmond
authors.initials: JD
authors.lastname: Allen
authors.forename: Colin
authors.initials: C
authors.lastname: Turner
authors.forename: John McC
authors.initials: JM
authors.lastname: Anderson
authors.forename: A A Jennifer
authors.initials: AA
authors.lastname: Adgey
mesh_terms: D000818:Animals; D047548:Defibrillators; D017097:Electric Impedance; D004562:Electrocardiography / Q000295:instrumentation; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D013552:Swine