Document Detail

Myocardial Substrate in Secondary Ventricular Fibrillation: Insights from Quantitative Waveform Measures.
MedLine Citation:
PMID:  21463200     Owner:  NLM     Status:  Publisher    
Abstract Background. Some patients presenting with nonshockable cardiac arrest rhythms will subsequently manifest ventricular fibrillation. Their prognosis remains poor despite transition to a shockable rhythm. Quantitative waveform measures assess the electrophysiologic status of the fibrillating heart and predict outcome. Objective. To use waveform measures to compare those who presented initially with ventricular fibrillation (primary group) with those who manifested ventricular fibrillation after initially presenting with a nonshockable arrest rhythm (secondary group). Methods. We conducted an observational study using a convenience sample to compare waveform measures of amplitude spectrum area (AMSA), cardioversion output predictor (COP), and detrended fluctuation analysis (DFA) prior to initial shock between the primary (n = 178) and secondary (n = 28) groups. We produced a primary group matched to the secondary group based on the average waveform values to evaluate the observed versus expected outcomes in the secondary group. Results. Survival was 42% in the primary group and 0% in the secondary group. There was a trend toward more favorable waveform values in the primary compared with the secondary group (9.48 versus 9.29, p = 0.10 for AMSA; 13.75 versus 14.12, p = 0.003 for COP; and 0.36 versus 0.44, p = 0.09 for DFA). The restricted, matched primary group experienced a survival of 37%, compared with 0% for the secondary group. Conclusions. Taken together, the findings suggest that the electrophysiologic status of the heart may be suitable for resuscitation in at least some secondary ventricular fibrillation cases and that other pathophysiology may contribute substantially to the poor prognosis. Alternately, waveform measures may not predict clinical outcomes in secondary ventricular fibrillation. Key words: ventricular fibrillation; secondary ventricular fibrillation; quantitative waveform measures; cardiac arrest.
Matthew Hall; Randi Phelps; Carol Fahrenbruch; Lawrence Sherman; Jennifer Blackwood; Thomas D Rea
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-4
Journal Detail:
Title:  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors     Volume:  -     ISSN:  1545-0066     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9703530     Medline TA:  Prehosp Emerg Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Case Western Reserve University School of Medicine (MH), Cleveland, Ohio; the Emergency Medical Services Division, Public Health Seattle & King County (RP, CF, JB, TDR), Seattle, Washington; and the University of Washington School of Medicine (RP, LS, TDR), Seattle, Washington.
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