PMID- 27784613 OWN - NLM STAT- MEDLINE DCOM- 20171201 LR - 20171222 IS - 1873-1570 (Electronic) IS - 0300-9572 (Linking) VI - 109 DP - 2016 Dec TI - Ventricular fibrillation waveform measures and the etiology of cardiac arrest. PG - 71-75 LID - S0300-9572(16)30510-X [pii] LID - 10.1016/j.resuscitation.2016.10.007 [doi] AB - BACKGROUND: Early determination of the acute etiology of cardiac arrest could help guide resuscitation or post-resuscitation care. In experimental studies, quantitative measures of the ventricular fibrillation waveform distinguish ischemic from non-ischemic etiology. METHODS: We investigated whether waveform measures distinguished arrest etiology among adults treated by EMS for out-of-hospital ventricular fibrillation between January 1, 2006-December 31, 2014. Etiology was classified using hospital information into three exclusive groups: acute coronary syndrome (ACS) with ST elevation myocardial infarction (STEMI), ACS without ST elevation (non-STEMI), or non-ischemic arrest. Waveform measures included amplitude spectrum area (AMSA), centroid frequency (CF), mean frequency (MF), and median slope (MS) assessed during CPR-free epochs immediately prior to the initial and second shock. Waveform measures prior to the initial shock and the changes between first and second shock were compared by etiology group. We a priori chose a significance level of 0.01 due to multiple comparisons. RESULTS: Of the 430 patients, 35% (n=150) were classified as STEMI, 29% (n=123) as non-STEMI, and 37% (n=157) with non-ischemic arrest. We did not observe differences by etiology in any of the waveform measures prior to shock 1 (Kruskal-Wallis Test) (p=0.28 for AMSA, p=0.07 for CF, p=0.63 for MF, and p=0.39 for MS). We also did not observe differences for change in waveform between shock 1 and 2, or when the two acute ischemia groups (STEMI and non-STEMI) were combined and compared to the non-ischemic group. CONCLUSION: This clinical investigation suggests that waveform measures may not be useful in distinguishing cardiac arrest etiology. CI - Copyright A(c) 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Hidano, Danelle AU - Hidano D AD - Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States. FAU - Coult, Jason AU - Coult J AD - Department of Bioengineering, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States. FAU - Blackwood, Jennifer AU - Blackwood J AD - Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States. FAU - Fahrenbruch, Carol AU - Fahrenbruch C AD - Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States. FAU - Kwok, Heemun AU - Kwok H AD - Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States. FAU - Kudenchuk, Peter AU - Kudenchuk P AD - Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States; Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States. FAU - Rea, Thomas AU - Rea T AD - Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States; Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States. Electronic address: rea123@u.washington.edu. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20161023 PL - Ireland TA - Resuscitation JT - Resuscitation JID - 0332173 SB - IM MH - Acute Coronary Syndrome/complications/diagnosis MH - Aged MH - Cardiopulmonary Resuscitation MH - Electric Countershock MH - *Electrocardiography MH - Emergency Medical Services MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/complications/diagnosis MH - Out-of-Hospital Cardiac Arrest/*etiology/mortality MH - Retrospective Studies MH - Ventricular Fibrillation/*complications/therapy OTO - NOTNLM OT - Cardiopulmonary resuscitation OT - Emergency cardiac care OT - Sudden cardiac death OT - Ventricular fibrillation EDAT- 2016/10/30 06:00 MHDA- 2017/12/02 06:00 CRDT- 2016/11/07 06:00 PHST- 2016/07/15 00:00 [received] PHST- 2016/09/27 00:00 [revised] PHST- 2016/10/06 00:00 [accepted] PHST- 2016/10/30 06:00 [pubmed] PHST- 2017/12/02 06:00 [medline] PHST- 2016/11/07 06:00 [entrez] AID - S0300-9572(16)30510-X [pii] AID - 10.1016/j.resuscitation.2016.10.007 [doi] PST - ppublish SO - Resuscitation. 2016 Dec;109:71-75. doi: 10.1016/j.resuscitation.2016.10.007. Epub 2016 Oct 23.