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Titolo:
Effects of biphasic vs monophasic defibrillation on the scaling exponent in a swine model of prolonged ventricular fibrillation
Autore:
Wang, HE; Menegazzi, JJ; Lightfoot, CB; Callaway, CW; Fertig, KC; Sherman, LD; Hsieh, M;
Indirizzi:
Univ Pittsburgh, Sch Med, Dept Emergency Med, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 ncy Med, Pittsburgh, PA 15213 USA
Titolo Testata:
ACADEMIC EMERGENCY MEDICINE
fascicolo: 8, volume: 8, anno: 2001,
pagine: 771 - 780
SICI:
1069-6563(200108)8:8<771:EOBVMD>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
HOSPITAL CARDIAC-ARREST; WAVE-FORM DEFIBRILLATION; 100 KG CALVES; TRANSTHORACIC DEFIBRILLATION; INTERNAL DEFIBRILLATION; RANDOMIZED EVALUATION; MEDIAN FREQUENCY; LEAD SYSTEM; EFFICACY; HUMANS;
Keywords:
ventricular fibrillation; scaling exponent; defibrillation; rescue shocks; waveforms;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
59
Recensione:
Indirizzi per estratti:
Indirizzo: Wang, HE Univ Pittsburgh, Sch Med, Dept Emergency Med, 230 McKee Pl,Suite 400, Pittsburgh, PA 15213 USA Univ Pittsburgh 230 McKee Pl,Suite 400 Pittsburgh PA USA 15213 SA
Citazione:
H.E. Wang et al., "Effects of biphasic vs monophasic defibrillation on the scaling exponent in a swine model of prolonged ventricular fibrillation", ACAD EM MED, 8(8), 2001, pp. 771-780

Abstract

Objective: Mathematical analyses of ventricular fibrillation (VF) have resulted in the derivation of a measure termed the scaling exponent (ScE) thatcharacterizes the duration of VF and probability of defibrillation success. The purpose of this study was to compare the effects of biphasic defibrillation waveform (BDW) and monophasic defibrillation waveform. (MDW) rescue shocks on ScE in a swine model of prolonged VF. Methods: Utstein guidelinesfor the laboratory study of cardiopulmonary resuscitation were followed. Twenty mixed-breed domestic swine (mass range 20.5-26.8 kg) were instrumented and randomized to receive either MDW or BDW rescue shocks. Ventricular fibrillation was induced and untreated for a nonintervention interval of 8 minutes. Rescue shocks were delivered at 8, 10, and 12 minutes of elapsed VF time. The energy sequence for the three MDW shocks was 70, 100, and 150 J (approximately 3, 4, and 6 J/kg). All BDW shocks were delivered at 50 J (approximately 2.5 J/kg). Only VF was shocked. Chest compressions and drugs were not provided. Rhythm analysis and ScE calculation were performed offline. Continuous and discontinuous linear regression models were fit to plots ofScE vs time. Defibrillation success and progression of ScE slope were analyzed using Fisher's exact test, paired t-tests, and repeated-measures analysis of variance (ANOVA). Results: Baseline characteristics were similar forboth groups. Successful termination of VF occurred on the first rescue shock in 1 of 10 (10%) in the MDW group and 3 of 10 (30%) in the BDW group; this difference was not statistically significant (p = 0.58). No other defibrillation successes were observed. No animals achieved return of spontaneouscirculation. The ScE values during the protocol progressed from 1.330 (95%CI = 1.287 to 1.373) to 1.724 (95% CI = 1.603 to 1.845) for MDW and 1.338 (95% CI = 1.261 to 1.415) to 1.639 (95% CI = 1.530 to 1.745) for BDW. Both groups showed a trend toward increasing ScE values with successive rescue shocks. Repeated-measures ANOVA using both continuous and discontinuous models demonstrated no difference in overall ScE slope progression between study groups. Conclusions: Mode of defibrillation waveform (BDW vs MDW) does not appear to impact ScE trends. Additional studies must be performed to better evaluate the clinical implications of this finding.

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Documento generato il 04/04/20 alle ore 13:24:00