Immediate defibrillation versus interventions first in a swine model of prolonged ventricular fibrillation

Menegazzi, James J.; Wang, Henry E.; Lightfoot, Christopher B.; Fertig, Kristofer C.; Chengelis, Nicole L.; Sherman, Lawrence; Callaway, Clifton W.

doi:10.1016/s0300-9572(03)00212-0

Cited by 34 publications

(16 citation statements)

References 26 publications

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“…[1][2][3] Animal studies, in contrast, have demonstrated superior survival rates with drug use. [4][5][6][7][8][9][10][11][12][13] One reason for failure of animal studies to translate to clinical practice may be the time at which the first drug is delivered. Previous work has demonstrated the average time to first drug administration in clinical trials is 19.4 minutes (range 13.3-25.0; 95% CI around the mean 12.8, 25.9).…”

Section: Introductionmentioning

confidence: 99%

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

2007

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Introduction-To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4 minutes. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials.Methods-We conducted a literature review between 1990 and 2006 in MEDLINE using the following MeSH headings: swine, dogs, resuscitation, heart arrest, EMS, EMT, ambulance, ventricular fibrillation, drug therapy, epinephrine, vasopressin, amiodarone, lidocaine, magnesium, and sodium bicarbonate. We reviewed the abstracts of 331 studies and 197 full manuscripts. Exclusion criteria included: non-peer reviewed, all without primary animal data, and traumatic models. From these, we identified 119 papers that contained unique information on time to medication administration. The data are reported as mean, ranges, and 95% confidence intervals. Mean time to first drug administration in animal laboratory studies and clinical trials was compared with a t-test. Regression analysis was performed to determine if time to drug predicted ROSC.Results-Mean time to first drug administration in 2378 animals was 9.5 minutes (range 3.0-28.0; 95% CI around mean 2. 78, 16.22). This is less than the time reported in clinical trials (19.4 min, p<0.001). Time to drug predicted ROSC (Odds Ratio 0.844; 95% CI 0.738, 0.966).Conclusion-Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena.

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Section: Introductionmentioning

confidence: 99%

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

2007

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“…The scaling exponent (ScE), LAC, and Hurst exponent have been well characterized in a large group of swine in earlier experimental work [7,9,14]. They show an increase in the fractal dimension over time.…”

Section: Discussionmentioning

confidence: 96%

“…[7,9] The three frequency based measures have been studied extensively and include median frequency, angular velocity, and frequency ratio [4][5][6][7][8]12,16]. Measures of the fractal dimension have also been developed to analyze VF and include the scaling exponent (ScE) [9,[13][14][15] and the logarithm of the absolute correlations (LAC) [17]. Another measure of fractal dimension is the Hurst exponent [7,[18][19][20].…”

Section: Introductionmentioning

confidence: 99%

The effect of ischemia on ventricular fibrillation as measured by fractal dimension and frequency measures

et al. 2007

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Introduction-Most animal studies of VF waveform characteristics involve healthy animals with VF initiated by electric shock. However, clinical VF is usually the result of ischemia. The waveform characteristics in these two types of VF may differ. The angular velocity (AV), frequency ratio (FR) and median frequency (MF) are three frequency based measures of VF. The scaling exponent (ScE), the logarithm of the absolute correlations (LAC) and the Hurst exponent (HE) are three measures of the fractal dimension of VF.

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“…ScE was recently introduced as a measure of ECG organization during VF [1][2][3][4][5][6][7][8][9]17]. It was postulated that ScE distinguishes "coarse" VF (low value of ScE close to 1) from "fine" VF (high value of ScE close to 2) and can provide a means to estimate VF duration [2] and to predict the outcome of rescue shocks [1].…”

Section: Is Sce a Reliable Measure Of Vf Organization?mentioning

confidence: 99%

“…Many attempts have been made to use the measures based on the ECG waveform in frequency and time domain as a means of assessing VF duration for optimization of the resuscitation strategies [1][2][3][4][5][6][7][8][9][10][11]. Accumulated clinical and laboratory data [1][2][3][4][5][6][7][8][9][10][11] have shown that these ECG waveform-based measures, or combinations of these measures, can help to predict the likelihood of the successful countershock therapy in cardiac arrest patients. However, analysis of ECG during VF can be confounded by extra-cardiac phenomena.…”

Section: Introductionmentioning

confidence: 99%

Influence of the skeletal muscle activity on time and frequency domain properties of the body surface ECG during evolving ventricular fibrillation in the pig

et al. 2008

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Aim of the study-To evaluate influence of the skeletal muscle activity (SMA) on time and frequency domain properties of ECG during VF.Materials and methods-We studied the first 9 minutes of electrically induced VF (N=7). We recorded Lead II ECG, 247 unipolar epicardial ventricular electrograms (UEGs) and 3 bipolar skeletal electromyograms (EMGs) near the positions of the ECG electrodes (sampling rate, 500Hz). We reconstructed ECG (RECG) from UEGs using forward-solution transformation matrix. Spectral properties of ECG, RECG, UEGs and MEGs were assessed in the range 2−250Hz by the median frequency (MF) and the upper limit of frequency range containing 99% of spectral energy (F lim (99)). Scaling exponent of ECG, RECG and EMGs was calculated in the ranges of 1−8 and 5−20 sampling intervals (ScE 1−8 and ScE 5−20 , respectively). Conclusion-SMA significantly contributes to ECG during VF and can bias metrics used for assessment of VF organization. Results-We observed non-monotonic increases in MF and

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Immediate defibrillation versus interventions first in a swine model of prolonged ventricular fibrillation

Cited by 34 publications

References 26 publications

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

The effect of ischemia on ventricular fibrillation as measured by fractal dimension and frequency measures

Influence of the skeletal muscle activity on time and frequency domain properties of the body surface ECG during evolving ventricular fibrillation in the pig

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