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Anesth Analg 2001;93:1428-1433
© 2001 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

The Predictive Value of Ventricular Fibrillation Electrocardiogram Signal Frequency and Amplitude Variables in Patients with Out-Of-Hospital Cardiac Arrest

Hans-Ulrich Strohmenger, MD*, Trygve Eftestol, PhD{dagger}, Kjetil Sunde, MD PhD{ddagger}, Volker Wenzel, MD*, Mechthild Mair, MD*, Hanno Ulmer, PhD§, Karl H. Lindner, MD*, and Petter A. Steen, MD PhD{ddagger}

Departments of *Anesthesiology and Critical Care Medicine and §Biostatistics, Leopold-Franzens University, Innsbruck, Austria; {dagger}Department of Electrical and Computer Engineering Hogskolen i Stavanger, Stavanger, Norway; and {ddagger}Department of Anesthesiology, Ulleval University Hospital, Oslo, Norway

Address correspondence and reprint requests to Hans-Ulrich Strohmenger, MD, Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens University, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to hans.strohmenger{at}uibk.ac.at

We evaluated ventricular fibrillation frequency and amplitude variables to predict successful countershock, defined as pulse-generating electrical activity. We also elucidated whether bystander cardiopulmonary resuscitation (CPR) influences these electrocardiogram (ECG) variables. In 89 patients with out-of-hospital cardiac arrest, ECG recordings of 594 countershock attempts were collected and analyzed retrospectively. By using fast Fourier transformation analysis of the ventricular fibrillation ECG signal in the frequency range 0.333–15 Hz (median [range]), median frequency, dominant frequency, spectral edge frequency, and amplitude were as follows: 4.4 (2.4–7.5) Hz, 4.0 (0.7–7.0) Hz, 7.7 (3.7–13.7) Hz, and 0.94 (0.24–1.95) mV, respectively, before successful countershock (n = 59). These values were 3.8 (0.8–7.7) Hz (P = 0.0002), 3.0 (0.3–9.7) Hz (P < 0.0001), 7.3 (2.0–14.0) Hz (P < 0.05), and 0.53 (0.03–3.03) mV (P < 0.0001), respectively, before unsuccessful countershock (n = 535). In patients in whom bystander CPR was performed (n = 51), ventricular fibrillation frequency and amplitude before the first defibrillation attempt were higher than in patients without bystander CPR (n = 38) (median frequency, 4.4 [2.4–7.5] vs 3.7 [1.8–5.3] Hz, P < 0.0001; dominant frequency, 3.8 [0.9–7.7] vs 2.6 [0.8–5.9] Hz, P < 0.0001; spectral edge frequency, 8.4 [4.8–12.9] vs 7.2 [3.9–12.1] Hz, P < 0.05; amplitude, 0.79 [0.06–4.72] vs 0.67 [0.16–2.29] mV, P = 0.0647). Receiver operating characteristic curves demonstrate that successful countershocks will be best discriminated from unsuccessful countershocks by ventricular fibrillation amplitude (3000-ms epoch). At 73% sensitivity, a specificity of 67% was obtained with this variable.

IMPLICATIONS: In patients with out-of-hospital cardiac arrest, successful countershocks will be best discriminated from unsuccessful countershocks by ventricular fibrillation amplitude (3000-ms epoch). At 73% sensitivity, a specificity of 67% was obtained with this variable.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2001 by the International Anesthesia Research Society.