TY - JOUR
T1 - Predictors of resuscitation outcome in a swine model of VF cardiac arrest
T2 - A comparison of VF duration, presence of acute myocardial infarction and VF waveform
AU - Indik, Julia H.
AU - Shanmugasundaram, Madhan
AU - Allen, Daniel
AU - Valles, Amanda
AU - Kern, Karl B.
AU - Hilwig, Ronald W.
AU - Zuercher, Mathias
AU - Berg, Robert A.
N1 - Funding Information:
This work was funded by a grant from the American Heart Association , AHA grant 0855587G .
Funding Information:
Dr. Robert Berg had research grants from the NIH to study post-shock chest compressions in swine after prolonged VF and received research funding from Laerdal. There are no conflicts of interest to disclose for Julia Indik, Madhan Shanmugasundaram, Ronald Hilwig, Karl Kern, Mathias Zuercher, Daniel Allen or Amanda Valles.
PY - 2009/12
Y1 - 2009/12
N2 - Introduction: Factors that affect resuscitation to a perfusing rhythm (ROSC) following ventricular fibrillation (VF) include untreated VF duration, acute myocardial infarction (AMI), and possibly factors reflected in the VF waveform. We hypothesized that resuscitation of VF to ROSC within 3 min is predicted by the VF waveform, independent of untreated VF duration or presence of acute MI. Methods: AMI was induced by the occlusion of the left anterior descending coronary artery. VF was induced in normal (N = 30) and AMI swine (N = 30). Animals were resuscitated after untreated VF of brief (2 min) or prolonged (8 min) duration. VF waveform was analyzed before the first shock to compute the amplitude-spectral area (AMSA) and slope. Results: Unadjusted predictors of ROSC within 3 min included untreated VF duration (8 min vs 2 min; OR 0.11, 95%CI 0.02-0.54), AMI (AMI vs normal; OR 0.11, 95%CI 0.02-0.54), AMSA (highest to lowest tertile; OR 15.5, 95%CI 1.7-140), and slope (highest to lowest tertile; OR 12.7, 95%CI 1.4-114). On multivariate regression, untreated VF duration (P = 0.011) and AMI (P = 0.003) predicted ROSC within 3 min. Among secondary outcome variables, favorable neurological status at 24 h was only predicted by VF duration (OR 0.22, 95% CI 0.05-0.92). Conclusions: In this swine model of VF, untreated VF duration and AMI were independent predictors of ROSC following VF cardiac arrest. AMSA and slope predicted ROSC when VF duration or the presence of AMI were unknown. Importantly, the initial treatment of choice for short duration VF is defibrillation regardless of VF waveform.
AB - Introduction: Factors that affect resuscitation to a perfusing rhythm (ROSC) following ventricular fibrillation (VF) include untreated VF duration, acute myocardial infarction (AMI), and possibly factors reflected in the VF waveform. We hypothesized that resuscitation of VF to ROSC within 3 min is predicted by the VF waveform, independent of untreated VF duration or presence of acute MI. Methods: AMI was induced by the occlusion of the left anterior descending coronary artery. VF was induced in normal (N = 30) and AMI swine (N = 30). Animals were resuscitated after untreated VF of brief (2 min) or prolonged (8 min) duration. VF waveform was analyzed before the first shock to compute the amplitude-spectral area (AMSA) and slope. Results: Unadjusted predictors of ROSC within 3 min included untreated VF duration (8 min vs 2 min; OR 0.11, 95%CI 0.02-0.54), AMI (AMI vs normal; OR 0.11, 95%CI 0.02-0.54), AMSA (highest to lowest tertile; OR 15.5, 95%CI 1.7-140), and slope (highest to lowest tertile; OR 12.7, 95%CI 1.4-114). On multivariate regression, untreated VF duration (P = 0.011) and AMI (P = 0.003) predicted ROSC within 3 min. Among secondary outcome variables, favorable neurological status at 24 h was only predicted by VF duration (OR 0.22, 95% CI 0.05-0.92). Conclusions: In this swine model of VF, untreated VF duration and AMI were independent predictors of ROSC following VF cardiac arrest. AMSA and slope predicted ROSC when VF duration or the presence of AMI were unknown. Importantly, the initial treatment of choice for short duration VF is defibrillation regardless of VF waveform.
KW - Cardiopulmonary resuscitation
KW - Defibrillation
KW - Heart arrest
KW - Myocardial infarction
KW - Ventricular fibrillation
KW - Ventricular fibrillation waveform
UR - http://www.scopus.com/inward/record.url?scp=70449712595&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70449712595&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2009.08.023
DO - 10.1016/j.resuscitation.2009.08.023
M3 - Article
C2 - 19804932
AN - SCOPUS:70449712595
VL - 80
SP - 1420
EP - 1423
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
IS - 12
ER -