Predicting defibrillation success.
OBJECTIVE
Ventricular fibrillation is the primary rhythm in many cardiac arrest patients. Since the late 1980s, the surface electrocardiogram of ventricular fibrillation has been subjected to analysis to obtain reliable information about the likelihood of successful countershock and to estimate the duration of cardiac arrest. Considerable efforts were made in the past 2 years to further improve the predictive power of rescue shock measures.


RESULTS
In a retrospective clinical study, ventricular fibrillation single feature analysis was not able to reliably estimate duration between cardiac arrest onset and initial electrocardiogram. Combining ventricular fibrillation features in the time and frequency domain by employing neural networks did not further improve the best single feature prediction power taken from higher ventricular fibrillation frequency bands. Cardioversion outcome prediction based on the wavelet technique increased the specificity up to 66% at the 95% sensitivity level.


CONCLUSIONS
Recent results question the ventricular fibrillation feature analysis as a reliable tool to estimate the duration of human cardiac arrest. Animal and clinical studies confirmed that ventricular fibrillation waveform analysis contains information to reliably predict the countershock success rate and further improved countershock outcome prediction. Prospective clinical studies are highly warranted to demonstrate that ventricular fibrillation waveform analysis definitely improves survival after cardiac arrest.
Strohmenger
Hans-Ulrich
HU
Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria. hans.strohmenger@i-med.ac.at
D004562:Electrocardiography; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D012372:ROC Curve; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*