心室颤动波形测量结合先前的电击结果可预测心肺复苏期间的除颤成功率。
Ventricular fibrillation waveform measures combined with prior shock outcome predict defibrillation success during cardiopulmonary resuscitation.
作者信息
Coult Jason, Kwok Heemun, Sherman Lawrence, Blackwood Jennifer, Kudenchuk Peter J, Rea Thomas D
机构信息
Department of Bioengineering, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA.
Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
出版信息
J Electrocardiol. 2018 Jan-Feb;51(1):99-106. doi: 10.1016/j.jelectrocard.2017.07.016. Epub 2017 Aug 1.
AIM
Amplitude Spectrum Area (AMSA) and Median Slope (MS) are ventricular fibrillation (VF) waveform measures that predict defibrillation shock success. Cardiopulmonary resuscitation (CPR) obscures electrocardiograms and must be paused for analysis. Studies suggest waveform measures better predict subsequent shock success when combined with prior shock success. We determined whether this relationship applies during CPR.
METHODS
AMSA and MS were calculated from 5-second pre-shock segments with and without CPR, and compared to logistic models combining each measure with prior return of organized rhythm (ROR).
RESULTS
VF segments from 692 patients were analyzed during CPR before 1372 shocks and without CPR before 1283 shocks. Combining waveform measures with prior ROR increased areas under receiver operating characteristic curves for AMSA/MS with CPR (0.66/0.68 to 0.73/0.74, p<0.001) and without CPR (0.71/0.72 to 0.76/0.76, p<0.001).
CONCLUSIONS
Prior ROR improves prediction of shock success during CPR, and may enable waveform measure calculation without chest compression pauses.
目的
振幅频谱面积（AMSA）和中位数斜率（MS）是预测除颤电击成功的室颤（VF）波形指标。心肺复苏（CPR）会干扰心电图，必须暂停以进行分析。研究表明，波形指标与先前的电击成功相结合时，能更好地预测后续电击成功。我们确定这种关系在心肺复苏期间是否适用。
方法
在有和没有心肺复苏的情况下，从电击前5秒的片段中计算AMSA和MS，并与将每种指标与先前的有组织节律恢复（ROR）相结合的逻辑模型进行比较。
结果
在1372次电击前的心肺复苏期间以及1283次电击前没有心肺复苏的情况下，分析了692例患者的室颤片段。将波形指标与先前的ROR相结合，增加了有CPR时AMSA/MS的受试者工作特征曲线下面积（从0.66/0.68增至0.73/0.74，p<0.001）以及无CPR时的曲线下面积（从0.71/0.72增至0.76/0.76，p<0.001）。
结论
先前的ROR可改善心肺复苏期间电击成功的预测，并可能无需暂停胸外按压就能进行波形指标计算。
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