The Sarver Heart Center at the University of Arizona College of Medicine, Tucson, AZ 85724-5037, United States.
Resuscitation. 2012 Oct;83(10):1242-7. doi: 10.1016/j.resuscitation.2012.02.008. Epub 2012 Feb 19.
In out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF), VF may recur during resuscitation (recurrent VF) or fail to defibrillate (shock-resistant VF). While retrospective studies have suggested that amplitude spectral area (AMSA) and slope predict defibrillation, it is unknown whether the predictive power is influenced by VF type. We hypothesized that in witnessed OHCA with initial rhythm of VF that the utility for AMSA and slope to predict defibrillation would differ between shock-resistant and recurrent VF.
AMSA and slope were measured immediately prior to each shock. For second or later shocks, VF was classified as recurrent or shock-resistant. Cardiac arrest was classified according to whether the majority of shocks were for recurrent VF or shock-resistant VF.
44 patients received 98 shocks for recurrent VF and 96 shocks for shock-resistant VF; 24 patients achieved ROSC in the field. AMSA and slope were higher in recurrent VF compared to shock-resistant VF (AMSA: 28.8±13.1 vs 15.2±8.6 mVHz, P<0.001, and slope: 2.9±1.4 vs 1.4±1.0 mVs(-1), P=0.001). Recurrent VF was more likely to defibrillate than shock-resistant VF (P<0.001). AMSA and slope predicted defibrillation in shock-resistant VF (P<0.001 for both AMSA and slope) but not in recurrent VF. Recurrent VF predominated in 79% of patients that achieved ROSC compared to 55% that did not (P=0.10).
In witnessed OHCA with VF as initial rhythm, recurrent VF is associated with higher values of AMSA and slope and is likely to re-defibrillate. However, when VF is shock-resistant, AMSA and slope are highly predictive of defibrillation.
在院外心脏骤停（OHCA）中，由于心室颤动（VF），VF 在复苏期间可能会再次发生（复发性 VF）或无法除颤（抗电击性 VF）。虽然回顾性研究表明幅度谱面积（AMSA）和斜率可预测除颤，但尚不清楚预测能力是否受 VF 类型的影响。我们假设在有目击者的 OHCA 中，初始节律为 VF，在抗电击性和复发性 VF 之间，AMSA 和斜率预测除颤的效果会有所不同。
在每次电击前立即测量 AMSA 和斜率。对于第二次或以后的电击，将 VF 分类为复发性或抗电击性。根据大多数电击是用于复发性 VF 还是抗电击性 VF，对心脏骤停进行分类。
44 名患者接受了 98 次复发性 VF 电击和 96 次抗电击性 VF 电击；24 名患者在现场恢复了自主循环。与抗电击性 VF 相比，复发性 VF 的 AMSA 和斜率更高（AMSA：28.8±13.1 与 15.2±8.6 mVHz，P<0.001，斜率：2.9±1.4 与 1.4±1.0 mVs(-1)，P=0.001）。复发性 VF 比抗电击性 VF 更有可能除颤（P<0.001）。AMSA 和斜率可预测抗电击性 VF 的除颤（AMSA 和斜率均 P<0.001），但不能预测复发性 VF。与未恢复自主循环的患者相比，在恢复自主循环的患者中，复发性 VF 占 79%，而未恢复自主循环的患者中占 55%（P=0.10）。
在有目击者的 OHCA 中，VF 作为初始节律时，复发性 VF 与更高的 AMSA 和斜率值相关，并且很可能再次除颤。然而，当 VF 具有抗电击性时，AMSA 和斜率高度预测除颤。
