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The effect of cardiopulmonary resuscitation on ventricular fibrillation waveform measures: a new tool to optimize in-field identification of an acute coronary occlusion during cardiac arrest

Waal, J.G. van der (2018) The effect of cardiopulmonary resuscitation on ventricular fibrillation waveform measures: a new tool to optimize in-field identification of an acute coronary occlusion during cardiac arrest.

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Abstract:Since the ventricular fibrillation (VF) waveform has been shown to decrease over time, it has been regarded as marker of arrest duration and has been investigated to predict defibrillation success. However, exact prediction of arrest duration is complicated by other factors also influencing the VF waveform. The VF waveform has been shown to increase with uninterrupted chest compressions, and decrease with pauses in chest compressions. Animal and human studies have also shown that myocardial infarction (MI) affects VF, and animal studies suggest that the change in VF waveform in response to cardiopulmonary resuscitation (CPR) may be altered in the presence of an acute coronary occlusion (ACO). This study investigated the change in VF waveform characteristics in relation to CPR quality, whether this is altered in the presence of an ACO, and whether this information can help in identifying these patients during out-of-hospital cardiac arrest (OHCA). For the change in VF characteristics in response to CPR, we compared this change between patients with and without adequate CPR (defined as chest compression fraction (CCF) � or < 0.6) between the first and second defibrillation. In a sub analysis we investigated this change in characteristics in a sub population of patients with and without ACO. In patients with CCF�0.6 (n=90), an increase in all VF amplitude characteristics was detected, while this did not occur in patients with CCF<0.6 (n=48). Furthermore, this numeric increase was significantly higher in patients with CCF�0.6 compared to patients with CCF<0.6. The sub analysis showed a difference in change in VF amplitude characteristics between CCF�0.6 and CCF<0.6 in patients without ACO (n=22), whereas this difference was not found in patients with ACO (n=38). Next the VF waveform parameters were investigated to determine their ability to predict the presence of an ACO. In patients with an underlying ACO (n=62), the VF amplitude characteristics were significantly lower when compared to patients without an underlying ACO (n=40), showing a limited discriminative ability with an AUC of 0.66. Combining the VF waveform parameter with the change in that parameter in response to CPR using binary logistic regression led to an improved discriminative ability, with an AUC of 0.75. These findings suggest that the VF waveform parameters and their change in response to CPR can be used to provide additional information to ensure correct and early triage of patients to the cardiac catheterization laboratory. Further studies are needed to determine if the combination of waveform parameters and their change in response to CPR can predict the presence of an ACO in a prospective fashion, and whether this results in improved survival after OHCA.
Item Type:Essay (Master)
Clients:
Radboud umc
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/74365
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