Scaling exponent predicts defibrillation success for out-of-hospital ventricular fibrillation cardiac arrest

被引:80
作者
Callaway, CW [1 ]
Sherman, LD [1 ]
Mosesso, VN [1 ]
Dietrich, TJ [1 ]
Holt, E [1 ]
Clarkson, MC [1 ]
机构
[1] Univ Pittsburgh, Dept Emergency Med, Pittsburgh, PA 15213 USA
关键词
fibrillation; heart arrest; defibrillation; electrocardiography; survival;
D O I
10.1161/01.CIR.103.12.1656
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Defibrillator shocks often fail to terminate ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OOHCA), and repeated failed shocks can worsen the subsequent response to therapy. Because the VF waveform changes with increasing duration of VF, it is possible that ECG analyses could estimate the preshock likelihood of defibrillation success. This study examined whether an amplitude-independent measure of preshock VF waveform morphology predicts outcome after defibrillation. Methods and Results-Clinical data and ECG recordings from an automated external defibrillator were obtained for 75 subjects with OOHCA in a suburban community with police first responders and a paramedic-based emergency medical system. An estimate of the fractal self-similarity dimension, the scaling exponent, was calculated off-line for the VF waveform preceding shocks. Success of the first shock was determined from the recordings. Return of pulses and survival were determined by chart review. The first shock resulted in an organized rhythm in 43% of cases, and 17% of cases survived to hospital discharge. A lower mean value of the scaling exponent was observed for cases in which the first defibrillation resulted in an organized rhythm (P=0.004), for cases with return of pulses (P=0.049), and for cases surviving to hospital discharge (P<0.001). Receiver operator curves revealed the utility of the scaling exponent for predicting the probability of restoring an organized rhythm (area under the curve=0.70) and of survival (area under the curve=0.84). Conclusions-The VF waveform in OOHCA can be quantified with the scaling exponent, which predicts the probability of first-shock defibrillation and survival to hospital discharge.
引用
收藏
页码:1656 / 1661
页数:6
相关论文
共 32 条
[1]   EFFECT OF OUT-OF-HOSPITAL DEFIBRILLATION BY BASIC LIFE-SUPPORT PROVIDERS ON CARDIAC-ARREST MORTALITY - A METAANALYSIS [J].
AUBLE, TE ;
MENEGAZZI, JJ ;
PARIS, PM .
ANNALS OF EMERGENCY MEDICINE, 1995, 25 (05) :642-648
[2]   Is the geometry of nature fractal? [J].
Avnir, D ;
Biham, O ;
Lidar, D ;
Malcai, O .
SCIENCE, 1998, 279 (5347) :39-40
[3]   Multicenter comparison of truncated biphasic shocks and standard damped sine wave monophasic shocks for transthoracic ventricular defibrillation [J].
Bardy, GH ;
Marchlinski, FE ;
Sharma, AD ;
Worley, SJ ;
Luceri, RM ;
Yee, R ;
Halperin, BD ;
Fellows, CL ;
Ahern, TS ;
Chilson, DA ;
Packer, DL ;
Wilber, DJ ;
Mattioni, TA ;
Reddy, R ;
Kronmal, RA ;
Lazzara, R .
CIRCULATION, 1996, 94 (10) :2507-2514
[4]   PROSPECTIVE EVALUATION OF INITIALLY INEFFECTIVE DEFIBRILLATION PULSES ON SUBSEQUENT DEFIBRILLATION SUCCESS DURING VENTRICULAR-FIBRILLATION IN SURVIVORS OF CARDIAC-ARREST [J].
BARDY, GH ;
IVEY, TD ;
JOHNSON, G ;
STEWART, RB ;
GREENE, HL .
AMERICAN JOURNAL OF CARDIOLOGY, 1988, 62 (10) :718-722
[5]   Effect of selective aortic arch perfusion on median frequency and peak amplitude of ventricular fibrillation in a canine model [J].
Barton, C ;
Manning, JE ;
Batson, N .
ANNALS OF EMERGENCY MEDICINE, 1996, 27 (05) :610-616
[6]   ESTIMATING THE DURATION OF VENTRICULAR-FIBRILLATION [J].
BROWN, CG ;
DZWONCZYK, R ;
WERMAN, HA ;
HAMLIN, RL .
ANNALS OF EMERGENCY MEDICINE, 1989, 18 (11) :1181-1185
[7]   Signal analysis of the human electrocardiogram during ventricular fibrillation: Frequency and amplitude parameters as predictors of successful countershock [J].
Brown, CG ;
Dzwonczyk, R .
ANNALS OF EMERGENCY MEDICINE, 1996, 27 (02) :184-188
[8]   PREHOSPITAL CARDIAC-ARREST TREATED BY URBAN 1ST-RESPONDERS - PROFILE OF PATIENT RESPONSE AND PREDICTION OF OUTCOME BY VENTRICULAR-FIBRILLATION WAVE-FORM [J].
CALLAHAM, M ;
BRAUN, O ;
VALENTINE, W ;
CLARK, DM ;
ZEGANS, C .
ANNALS OF EMERGENCY MEDICINE, 1993, 22 (11) :1664-1677
[9]   Scaling structure of electrocardiographic waveform during prolonged ventricular fibrillation in swine [J].
Callaway, CW ;
Sherman, LD ;
Scheatzle, MD ;
Menegazzi, JJ .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2000, 23 (02) :180-191
[10]   Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation [J].
Cobb, LA ;
Fahrenbruch, CE ;
Walsh, TR ;
Copass, MK ;
Olsufka, M ;
Breskin, M ;
Hallstrom, AP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 281 (13) :1182-1188