Logarithm of the absolute correlations of the ECG waveform estimates duration of ventricular fibrillation and predicts successful defibrillation.
BACKGROUND
Measures of the ventricular fibrillation (VF) waveform may enable better allocation of cardiac arrest treatment by discriminating which patients should receive immediate defibrillation versus alternate therapies such as CPR. We derive a new measure based on the 'roughness' of the VF waveform, the Logarithm of the Absolute Correlations (LAC), and assess and contrast how well the LAC and the previously published scaling exponent (ScE) predict the duration of VF and the likelihood of return of spontaneous circulation (ROSC) under both optimal experimental and commercial-defibrillator sampling conditions.


RESULTS
We derived the LAC and ScE from two different populations--an animal study of 44 swine and a retrospective human sample of 158 out-of-hospital VF arrests treated with a commercial defibrillator. In the animal study, the LAC and ScE were calculated on 5s epochs of VF recorded at 1000 samples/s and then down sampled to 125 samples/s. In the human study, the LAC and ScE were calculated using 6s epochs recorded at 200 samples/s that occurred immediately prior to the initial shock. We compared the LAC and ScE measures using the Spearman correlation coefficients (CC) and areas under the receiver operating characteristic curve (AUC).


RESULTS
In the animal study, the LAC and ScE were highly correlated at 1000 sample/s (CC=0.93) but not at 125 samples/s (CC=-0.06). These correlations were reflected in how well the measures discriminated VF of < or =5 versus >5 min: AUC at 1000 samples/s was similar for LAC compared to ScE (0.71 versus 0.76). However AUC at 125 samples was greater for LAC compared to ScE (0.75 versus 0.62). In the human study, the LAC measure was a better predictor of ROSC following initial defibrillation as reflected by an AUC of 0.77 for LAC compared to 0.57 for ScE.


CONCLUSIONS
The LAC is an improvement over the ScE because the LAC retains its prognostic characteristics at lower ECG sampling rates typical of current clinical defibrillators. Hence, the LAC may have a role in better allocating treatment in resuscitation of VF cardiac arrest.
Sherman
Lawrence D
LD
Emergency Department, St. Francis Hospital, 34515 Ninth Ave. S. Federal Way, WA 98003, USA. SHERMLD@COMCAST.NET
Rea
Thomas D
TD
Waters
James D
JD
Menegazzi
James J
JJ
Callaway
Clifton W
CW
D000465:Algorithms; D000818:Animals; D047548:Defibrillators; D004554:Electric Countershock; D004562:Electrocardiography; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*