From the IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (G.R., A.F., F.F., R.L.); Department of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, and University of Milano-Bicocca, Milan, Italy (T.M., G.R., A.P.); Research Center on Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy (G.C., C.F.); School of Biomedical Engineering, Third Military Medical University and Chongqing University, Chongqing, China (Y.L.); and Azienda Regionale Emergenza Urgenza (AREU), Milan, Italy (G.R., N.G., M.M., A.A., A.P.).
Circulation. 2015 Feb 3;131(5):478-87. doi: 10.1161/CIRCULATIONAHA.114.010989. Epub 2014 Dec 2.
This study sought to validate the ability of amplitude spectrum area (AMSA) to predict defibrillation success and long-term survival in a large population of out-of-hospital cardiac arrests.
ECGs recorded by automated external defibrillators from different manufacturers were obtained from patients with cardiac arrests occurring in 8 city areas. A database, including 2447 defibrillations from 1050 patients, was used as the derivation group, and an additional database, including 1381 defibrillations from 567 patients, served as validation. A 2-second ECG window before defibrillation was analyzed, and AMSA was calculated. Univariable and multivariable regression analyses and area under the receiver operating characteristic curve were used for associations between AMSA and study end points: defibrillation success, sustained return of spontaneous circulation, and long-term survival. Among the 2447 defibrillations of the derivation database, 26.2% were successful. AMSA was significantly higher before a successful defibrillation than a failing one (13 ± 5 versus 6.8 ± 3.5 mV-Hz) and was an independent predictor of defibrillation success (odds ratio, 1.33; 95% confidence interval, 1.20-1.37) and sustained return of spontaneous circulation (odds ratio, 1.22; 95% confidence interval, 1.17-1.26). Area under the receiver operating characteristic curve for defibrillation success prediction was 0.86 (95% confidence interval, 0.85-0.88). AMSA was also significantly associated with long-term survival. The following AMSA thresholds were identified: 15.5 mV-Hz for defibrillation success and 6.5 mV-Hz for defibrillation failure. In the validation database, AMSA ≥ 15.5 mV-Hz had a positive predictive value of 84%, whereas AMSA ≤ 6.5 mV-Hz had a negative predictive value of 98%.
In this large derivation-validation study, AMSA was validated as an accurate predictor of defibrillation success. AMSA also appeared as a predictor of long-term survival.
本研究旨在验证幅度谱面积（AMSA）在预测院外心脏骤停患者除颤成功和长期生存方面的能力。
从 8 个城市地区发生心脏骤停的患者中获得了不同制造商的自动体外除颤器记录的心电图。一个包含 1050 例患者 2447 次除颤的数据库被用作推导组，另一个包含 567 例患者 1381 次除颤的数据库被用作验证组。分析除颤前 2 秒的心电图窗口，并计算 AMSA。采用单变量和多变量回归分析以及受试者工作特征曲线下面积来评估 AMSA 与研究终点之间的关系：除颤成功、持续自主循环恢复和长期生存。在推导数据库的 2447 次除颤中，26.2%成功。与失败的除颤相比，成功的除颤前 AMSA 显著更高（13±5 对 6.8±3.5 mV-Hz），并且是除颤成功（优势比，1.33；95%置信区间，1.20-1.37）和持续自主循环恢复（优势比，1.22；95%置信区间，1.17-1.26）的独立预测因子。除颤成功预测的受试者工作特征曲线下面积为 0.86（95%置信区间，0.85-0.88）。AMSA 也与长期生存显著相关。确定了以下 AMSA 阈值：15.5 mV-Hz 用于除颤成功，6.5 mV-Hz 用于除颤失败。在验证数据库中，AMSA≥15.5 mV-Hz 的阳性预测值为 84%，而 AMSA≤6.5 mV-Hz 的阴性预测值为 98%。
在这项大型推导验证研究中，AMSA 被验证为除颤成功的准确预测因子。AMSA 似乎也是长期生存的预测因子。
