This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Strohmenger, H.-U. Articles by Steen, P. A. Search for Related Content PubMed PubMed Citation Articles by Strohmenger, H.-U. Articles by Steen, P. A. Related Collections Resuscitation Monitoring (Cardiac)

---

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, Kjetil Sunde, MD PhD, Volker Wenzel, MD^*, Mechthild Mair, MD^*, Hanno Ulmer, PhD, Karl H. Lindner, MD^*, and Petter A. Steen, MD PhD

Departments of *Anesthesiology and Critical Care Medicine and Biostatistics, Leopold-Franzens University, Innsbruck, Austria; Department of Electrical and Computer Engineering Hogskolen i Stavanger, Stavanger, Norway; and 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.

This article has been cited by other articles:

				I. Panfilov, N. A. Lever, B. H. Smaill, and P. D. Larsen Ventricular fibrillation frequency from implanted cardioverter defibrillator devices Europace, August 1, 2009; 11(8): 1052 - 1056. [Abstract] [Full Text] [PDF]

				J. H. Indik, R. W. Hilwig, M. Zuercher, K. B. Kern, M. D. Berg, and R. A. Berg Preshock Cardiopulmonary Resuscitation Worsens Outcome From Circulatory Phase Ventricular Fibrillation With Acute Coronary Artery Obstruction in Swine Circ Arrhythm Electrophysiol, April 1, 2009; 2(2): 179 - 184. [Abstract] [Full Text] [PDF]

				Part 5: Electrical Therapies: Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing Circulation, December 13, 2005; 112(24_suppl): IV-35 - IV-46. [Full Text] [PDF]

				Part 3: Defibrillation Circulation, November 29, 2005; 112(22_suppl): III-17 - III-24. [Full Text] [PDF]

				K. H. Stadlbauer, K. Rheinberger, V. Wenzel, C. Raedler, A. C. Krismer, H.-U. Strohmenger, S. Augenstein, H. G. Wagner-Berger, W. G. Voelckel, K. H. Lindner, et al. The Effects of Nifedipine on Ventricular Fibrillation Mean Frequency in a Porcine Model of Prolonged Cardiopulmonary Resuscitation Anesth. Analg., July 1, 2003; 97(1): 226 - 230. [Abstract] [Full Text] [PDF]