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CRITICAL CARE AND TRAUMA

Ventricular Fibrillation Median Frequency May Not Be Useful for Monitoring During Cardiac Arrest Treated with Endothelin-1 or Epinephrine

Michael Holzer, MD^*, Wilhelm Behringer, MD^*, Fritz Sterz, MD^*, Julia Kofler, MD^*, Elisabeth Oschatz, MD^*, Ernst Schuster, PhD, and Anton N. Laggner, MD^*

Departments of *Emergency Medicine and Medical Computer Sciences, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Prof. Dr. Fritz Sterz, Universitätsklinik für Notfallmedizin, Allgemeines Krankenhaus der Stadt Wien, 1090 Wien, Währinger Gürtel 18-20 (6/D), Austria. Address e-mail to fritz.sterz{at}meduniwien.ac.at

In this study, we evaluated whether median fibrillation frequency (MF) and mean fibrillation amplitude (AMP) reflect coronary perfusion pressure (CoPP) and predict successful defibrillation. MF, AMP, and CoPP were measured during prolonged ventricular fibrillation (VF) cardiac arrest and resuscitation in pigs. After 5 min of VF, cardiopulmonary resuscitation was started. At 10 min, the pigs received randomly a single dose of endothelin-1 50 µg (n = 7), 100 µg (n = 7), or 200 µg (n = 5), or repeated doses of epinephrine 0.04 mg/kg (n = 6), or saline (n = 6) every 3 min. At 25 min, the pigs were defibrillated to achieve restoration of spontaneous circulation (ROSC). In a nonparametric spectral analysis of the individual MF versus CoPP and AMP versus CoPP curves, we found no link between the different curves in different animals or therapies. No difference was found in MF in pigs with ROSC (n = 8) compared with animals not achieving ROSC (n = 23) immediately before defibrillation (P = 0.85). Our data suggest that, in prolonged VF cardiac arrest, MF and AMP might not be useful tools to reflect myocardial perfusion.

IMPLICATIONS: Median fibrillation frequency (MF) has been suggested as an online monitoring tool during resuscitation. In a pig model, during prolonged resuscitation, we compared the individual curves of MF, mean fibrillation amplitude, and coronary perfusion pressure and found that MF was not useful for monitoring resuscitation efforts.