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Electrocardiographic prediction of the success of cardiac resuscitation

Noc, Marko MD; Weil, Max Harry MD, PhD, FCCM; Tang, Wanchun MD, FCCM; Sun, Shijie MD; Pernat, Andrej MD; Bisera, Joe MSEE

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Objectives To identify a method for predicting the success or failure of a defibrillatory shock such as to avoid potentially detrimental interruptions of cardiopulmonary resuscitation (CPR). Such a method would also guide more optimal programming of automated external defibrillators.

Design Prospective, observational animal study.

Setting Medical research laboratory in a university-affiliated research and educational foundation.

Subjects Domestic pigs.

Interventions Ventricular fibrillation (VF) was electrically induced in 66 domestic pigs. After an interval of between 3 and 5 mins of untreated VF, precordial compression was begun. Electrocardiographic lead 2 was monitored and artifacts produced during precordial compression were removed by digital filtering.

Measurements and Main Results In the derivation study, electrical defibrillation restored spontaneous circulation in 30 of the 66 animals. Successfully resuscitated animals had significantly greater coronary perfusion pressure, maximum VF amplitude, mean VF amplitude, and dominant VF frequency. No animals were resuscitated if the coronary perfusion pressure was <8 mm Hg, maximum amplitude was <0.48 mV, mean amplitude was <0.25 mV, or dominant frequency <9.9 Hz independently of the duration of untreated VF. When mean amplitude and dominant frequency were combined, the predictability was further improved. In an additional validation study of 14 animals, consecutive defibrillations were uniformly unsuccessful if the combination of mean amplitude and dominant frequency did not exceed the threshold values obtained in derivation study.

Conclusion Mean VF amplitude alone or in combination with dominant frequency of VF was expressed as a numerical score. It served as an objective noninvasive measurement on a par with that of coronary perfusion pressure for predicting the success of defibrillation. As such, it minimizes the detriment of repetitively interrupting mechanical interventions during CPR for electrical defibrillation when an electrical shock predictably fails to restore an effective rhythm. (Crit Care Med 1999; 27:708-714)

From the Institute of Critical Care Medicine, Palm Springs, CA; and the University of Southern California School of Medicine, Los Angeles, CA; and the Center for Intensive Internal Medicine (Dr. Noc), University Clinical Center, Ljubljana, Slovenia.

Supported in part by grants-in-aid from the Mary Pickford Foundation of Beverly Hills, CA, and the Laerdal Foundation of Stavanger, Norway.

Drs. Weil and Tang and Mr. Bisera are applicants for a U.S. patent on "Electrocardiographic predictor of the success of cardiac defibrillation." All benefits of the invention have been assigned by the inventors to the Institute of Critical Care Medicine, a not-for-profit research and educational foundation.

Address requests for reprints to: Max Harry Weil, MD, PhD, FCCM, Institute of Critical Care Medicine, 1695 North Sunrise Way, Bldg. #3, Palm Springs, CA 92262-5309.

© 1999 Lippincott Williams & Wilkins, Inc.