Amiodarone and amplitude spectral area of ventricular fibrillation in patients with out-of-hospital cardiac arrest

Abstract Background Ventricular fibrillation is the most common cause of out-of-hospital cardiac arrest (OHCA) and the use of antiarrhythmic drug therapy is usually recommended in addition to defibrillation. The role of the amplitude spectral area (AMSA) of ventricular fibrillation as a predictor of defibrillation efficacy has been established, while the existing data in favour of the use of amiodarone has been assessed with poor evidence and controversy. Purpose The aim of our study is to evaluate whether the administration of amiodarone during resuscitation could affect AMSA values. Materials All the OHCAs with a shockable presenting rhythm and attempted resuscitation which occurred from January 2015 to June 2019 in the province of Pavia were considered. Both the end-tidal CO2 (ETCO2) and AMSA values were calculated by retrospectively analyzing the data collected by the Corpuls 3 monitors/defibrillators (Corpuls, Kaufering, Germany) used in the territory and by considering a pre-shock interval of 2 seconds. Results Among a total of 3413 OHCAs, resuscitation was attempted in 2195 cases (64%), 377 (17%) had a shockable presenting rhythm and in 112 cases (3.4%) it was possible to obtain the values of ETCO2 and AMSA for a total of 391 shocks. Among these, 301 shocks (77%) were delivered to patients who received amiodarone during resuscitation. The success rate of each single shock was similar in the two groups but with an unfavorable trend for amiodarone (amiodarone 43.5% vs no amiodarone 54.4%, p=0.07). AMSA was significantly lower in patients treated with amiodarone (7.9 mV·Hz, IQR 5.4–12.2 vs 10.6 mV·Hz, IQR 7.1–14.1; p<0.001). According to a multivariate analysis, the administration of amiodarone and the time to shock were independent predictors of AMSA values. Lastly, on a sample of 124 shocks, homogeneous for age, sex, ETCO2, outcome of resuscitation and randomly matched, the AMSA of patients who received amiodarone was significantly lower (7.2 mV·Hz, IQR 7.2–11.7 vs 9.7 mV·Hz, IQR 6.7–12.5; p=0.02). Conclusions Our results indicate that amiodarone administration is associated with lower values of AMSA. Since higher AMSA values are known to be associated with a higher probability of shock rate success, this could help to better clarify the controversial role of amiodarone administration in patients with OHCA. FUNDunding Acknowledgement Type of funding sources: None.

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End-tidal carbon dioxide (ETCO2) and ventricular fibrillation amplitude spectral area (AMSA) for shock outcome prediction in out-of-hospital cardiac arrest. Are they two sides of the same coin?

Resuscitation ◽

10.1016/j.resuscitation.2020.10.032 ◽

2020 ◽

Author(s):

Laura Frigerio ◽

Enrico Baldi ◽

Elisabete Aramendi ◽

Beatriz Chicote ◽

Unai Irusta ◽

...

Keyword(s):

Carbon Dioxide ◽

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Outcome Prediction ◽

End Tidal Carbon Dioxide ◽

Spectral Area ◽

End Tidal ◽

Two Sides ◽

Hospital Cardiac Arrest ◽

Shock Outcome

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The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity

Resuscitation ◽

10.1016/j.resuscitation.2021.08.014 ◽

2021 ◽

Vol 167 ◽

pp. 76-81

Author(s):

Michael Crickmer ◽

Ian R. Drennan ◽

Linda Turner ◽

Sheldon Cheskes

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

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Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?

Circulation ◽

10.1161/circ.130.suppl_2.12769 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Julia Indik ◽

Zacherie Conover ◽

Meghan McGovern ◽

Annemarie Silver ◽

Daniel Spaite ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Hospital Discharge ◽

Chest Compression ◽

Stepwise Logistic Regression ◽

Individual Subject ◽

Spectral Area ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectral area (AMSA) predicts defibrillation success and is associated with survival to hospital discharge. We evaluated the relative strength of factors associated with hospital discharge including witnessed/unwitnessed status, chest compression (CC) quality and AMSA. We then investigated if there is a threshold value for AMSA that can identify patients who are unlikely to survive. Methods: Adult OHCA patients (age ≥18), with initial rhythm of VF from an Utstein-Style database (collected from 2 EMS systems) were analyzed. AMSA was measured from the waveform immediately prior to each shock, and averaged for each individual subject (AMSA-ave). Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed: age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, mean CC rate, depth, and release velocity (RV). Results: 140 subjects were analyzed, [104 M (74%), age 62 ± 14 yrs, witnessed 65%]. Survival was 38% in witnessed and 16% in unwitnessed arrest. In univariate analyses, age (P=0.001), witnessed status (P=0.009), AMSA-ave (P<0.001), mean CC depth (P=0.025), and RV (P< 0.001) were associated with survival. Stepwise logistic regression identified AMSA-ave (P<0.001), RV (P=0.001) and age (P=0.018) as independently associated with survival. The area under the curve (ROC analysis) was 0.849. The probability of survival was < 5% in witnessed arrest for AMSA-ave < 5 mV-Hz, and in unwitnessed arrest for AMSA-ave < 15 mV-Hz. Conclusion: In OHCA with an initial rhythm of VF, AMSA-ave and CC RV are highly associated with survival. Further study is needed to evaluate whether AMSA-ave may be useful to identify patients highly unlikely to survive.

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