Office of Medical Affairs, Fire Department of New York, 9 MetroTech Center, Brooklyn, NY 11201, USA.
Circulation. 2013 Aug 27;128(9):995-1002. doi: 10.1161/CIRCULATIONAHA.113.003273.
Ventricular fibrillation (VF) waveform properties have been shown to predict defibrillation success and outcomes among patients treated with immediate defibrillation. We postulated that a waveform analysis algorithm could be used to identify VF unlikely to respond to immediate defibrillation, allowing selective initial treatment with cardiopulmonary resuscitation in an effort to improve overall survival.
In a multicenter, double-blind, randomized study, out-of-hospital cardiac arrest patients in 2 urban emergency medical services systems were treated with automated external defibrillators using either a VF waveform analysis algorithm or the standard shock-first protocol. The VF waveform analysis used a predefined threshold value below which return of spontaneous circulation (ROSC) was unlikely with immediate defibrillation, allowing selective treatment with a 2-minute interval of cardiopulmonary resuscitation before initial defibrillation. The primary end point was survival to hospital discharge. Secondary end points included ROSC, sustained ROSC, and survival to hospital admission. Of 6738 patients enrolled, 987 patients with VF of primary cardiac origin were included in the primary analysis. No immediate or long-term survival benefit was noted for either treatment algorithm (ROSC, 42.5% versus 41.2%, P=0.70; sustained ROSC, 32.4% versus 33.4%, P=0.79; survival to admission, 34.1% versus 36.4%, P=0.46; survival to hospital discharge, 15.6% versus 17.2%, P=0.55, respectively).
Use of a waveform analysis algorithm to guide the initial treatment of out-of-hospital cardiac arrest patients presenting in VF did not improve overall survival compared with a standard shock-first protocol. Further study is recommended to examine the role of waveform analysis for the guided management of VF.
已表明心室颤动（VF）的波形特征可预测接受即刻除颤治疗的患者的除颤成功率和结局。我们推测，可以使用波形分析算法来识别不太可能对即刻除颤有反应的 VF，从而选择性地在初始阶段进行心肺复苏治疗，以提高整体生存率。
在一项多中心、双盲、随机研究中，2 个城市的院前心脏骤停患者在使用自动体外除颤器治疗时，分别使用 VF 波形分析算法或标准即刻除颤方案。VF 波形分析使用了一个预先定义的阈值，低于该阈值，即刻除颤时恢复自主循环（ROSC）的可能性较小，允许在初始除颤前选择性地进行 2 分钟的心肺复苏治疗。主要终点是存活至出院。次要终点包括 ROSC、持续 ROSC 和存活至入院。在纳入的 6738 例患者中，有 987 例原发性心源性 VF 患者纳入主要分析。两种治疗方案均未观察到即刻或长期生存获益（ROSC：42.5%比 41.2%，P=0.70；持续 ROSC：32.4%比 33.4%，P=0.79；存活至入院：34.1%比 36.4%，P=0.46；存活至出院：15.6%比 17.2%，P=0.55）。
与标准即刻除颤方案相比，使用波形分析算法指导 VF 院前心脏骤停患者的初始治疗并未改善整体生存率。建议进一步研究，以检查波形分析在指导 VF 管理中的作用。
