Irregularity test for very short electrocardiogram (ECG) signals as a method for predicting a successful defibrillation in patients with ventricular fibrillation

Part 8: Adult Advanced Cardiovascular Life Support

“…141,[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][164][165][166] No prospective human studies have specifically evaluated whether treatment altered by predicting success of defibrillation can improve successful defibrillation, rate of ROSC, or survival from cardiac arrest. The value of VF waveform analysis to guide management of defibrillation in adults with in-hospital and out-of-hospital cardiac arrest is uncertain (Class IIb, LOE C).…”

Part 6: Defibrillation

“…Retrospective analysis of the VF waveform in multiple clinical (LOE 1 134,135 ; LOE 4 136 -154 ; LOE 5 155,156 ) and animal studies (LOE 5) 147,[157][158][159][160][161][162][163][164][165][166][167][168][169][170] and theoretical models suggested that it is possible to predict the success of defibrillation from the fibrillation waveform with varying reliability. One animal study was neutral (LOE 5).…”

Predicting defibrillation success

“…Jagric et al [17] investigated in a retrospective and blinded fashion, 120 initial ventricular fibrillation recordings from patients with out-of-hospital cardiac arrest. They were able to analyze the irregularity level in very short ventricular fibrillation signal periods, and found that a higher level of dynamic complexity of the ECG activity (reflected by a higher k value) was associated with higher defibrillation success rate.…”

“…However, no area under the curve (AUC) values of the receiver operating characteristic (ROC) curves are given for the feature investigated, and therefore, the results cannot be compared to the predictive power of other ventricular fibrillation features. In addition, the results obtained from a retrospective study [17] were not tested prospectively and separately in an independent dataset.…”