Optimizing timing of ventricular defibrillation
Optimizing timing of ventricular defibrillation
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DOI：
10.1097/00003246-200112000-00019
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发表时间：
2001-12-01
影响因子：
8.8
通讯作者：
Bisera, J
中科院分区：
文献类型：
--
作者：
Marn-Pernat, A;Weil, MH;Bisera, J
目的：我们的目的是发展一种能够预测电击恢复灌注节律的可能性的预测器。这样一个心电图仪是基于传统的心电图信号，但没有由心前区压迫造成的伪影所造成的限制。因此，节律分析的“放手”间期的不良影响将最小化。这样的一个adminsticator进一步旨在减少电击的数量和总能量的传递，从而最大限度地减少复苏后心肌功能障碍。一所大学附属研究和教育机构的医学研究实验室。主题：家猪。干预。在建立的心脏骤停猪模型中诱导心室颤动。在4-48 Hz的频率范围内使用标量导联2的记录。代表振幅和频率的曲线下面积被定义为振幅谱面积（AMSA）。衍生组的55只动物产生了AMSA的阈值，一致预测成功复苏。一个单独的10只动物的组，验证组，证实了AMSA值为21 mV-Hz预测灌注节律恢复后7/8电击和失败的21/23电击的电转换，产生约90%的灵敏度和特异性。AMSA的阴性预测值为95%，在统计学上与冠状动脉灌注压、平均振幅和中位频率相当。与冠状动脉灌注压（42%）、平均振幅（32%）和中位频率（29%）相比，AMSA（78%）的阳性预测值（提示继续心肺复苏而不中断除颤尝试）大大提高。AMSA有可能指导更佳的除颤时机，而不会对心肺复苏造成不利影响，也不会输送不成功的高能电除颤。导致复苏后心肌损伤的休克。
Objective: Our intent was to evolve a prognosticator that would predict the likelihood that an electrical shock would restore a perfusing rhythm. Such a prognosticator was to be based on conventional electrocardiographic signals but without constraints caused by artifacts resulting from precordial compression. The adverse effects of "hands off" intervals for rhythm analyses would therefore be minimized. Such a prognosticator was further intended to reduce the number of electrical shocks and the total energy delivered and thereby minimize postresuscitation myocardial dysfunction.Design: Observational study.Subjects. Medical research laboratory of a university-affiliated research and educational institute.Subjects: Domestic pigs.Interventions. Ventricular fibrillation was induced in an established porcine model of cardiac arrest. Recordings of scalar lead 2 over the frequency range of 4-48 Hz were utilized. The area under the curve representing the amplitude and frequency was defined as the amplitude spectrum area (AMSA).Measurements and Main Results. A derivation group of 55 animals yielded a threshold value of AMSA that uniformly predicted successful resuscitation. A separate group of 10 animals, a validation group, confirmed that an AMSA value of 21 mV-Hz predicted restoration of perfusing rhythm after 7 of 8 electrical shocks and failure of electrical conversion in 21 of 23 electrical shocks, yielding sensitivity and specificity of about 90%. The negative predictive value of AMSA was 95% and statistically equivalent to that of coronary perfusion pressure, mean amplitude, and median frequency. The positive predictive value that would prompt continuation of cardiopulmonary resuscitation without interruption for an unsuccessful defibrillation attempt was greatly improved with AMSA (78%) as compared with coronary perfusion pressure (42%), mean amplitude (32%), and median frequency (29%).Conclusion: AMSA has the potential for guiding more optimal timing of defibrillation without adverse interruption of cardiopulmonary resuscitation or the delivery of unsuccessful high energy electrical shocks that contribute to postresuscitation myocardial injury.