Background: Amplitude spectral area (AMSA) of ventricular fibrillation (VF) is a surrogate for the metabolic status of the heart and is able to predict shock success and return of a spontaneous circulation (ROSC). There is very little evidence, and limited to short-term outcome, of the association between Amplitude Spectral Area (AMSA) of ventricular fibrillation and survival after Out-of-Hospital Cardiac Arrest (OHCA). Purpose: we aimed to assess whether AMSA could stratify the risk of death or poor neurological outcome in patients with initial shockable rhythm or initial non-shockable rhythm with conversion to a shockable one, both at 30 days and at one year from OHCA. Methods: this is a multicentre study based on retrospective analysis of prospectively collected data in two European Utstein based OHCA registries. We included all OHCAs with at least one manual defibrillation. AMSA values were calculated after data extraction from the monitors/defibrillators used in the field by using a 2-second-pre-shock electrocardiogram interval. The first AMSA detected, the maximum, the average and the minimum values were computed and their outcome prediction accuracy was compared. Results: Of the 578 patients included 504 died or had a poor neurological outcome. All the AMSA values considered were significantly higher in survivors with good neurological outcome, and the average AMSA showed the highest Area Under the ROC Curve [0.778, (95%CI: 0.74-0.81), p<0.01]. After correction for confounders the highest tertiles of average AMSA (T3 and T2) were significantly associated with a lower risk of death or poor neurological outcome compared to T1 both at 30 days [T2: HR 0.7 (95%CI 0.5-0.9), p =0.003; T3: HR 0.6 (95%CI 0.4-0.7), p<0.001] and at one year [T2: HR 0.6 (95%CI 0.4-0.9), p =0.005; T3: HR 0.5 (95%CI 0.4-0.8), p<0.003]. Moreover, among survivors at 30 days, lower AMSA was associated with mortality or poor neurological outcome at one year [T2: HR 0.1 (95%CI 0.1-0.9), p =0.04; T3: HR 0.01 (95%CI 0.-0.3), p=0.005]. Conclusion: AMSA was significantly and independently associated with the risk of death or poor neurological outcome at 30 days and at 1 year in OHCA patients. The average AMSA had the closest association with prognosis.
ESTRATTO Introduzione: l’ampiezza dell’area spettrale della fibrillazione ventricolare (AMSA) è un indicatore dello stato metabolico del cuore ed è in grado di predire il successo dello shock e il ritorno alla circolazione spontanea (ROSC). Le prove riguardanti il ruolo dell’AMSA come predittore di sopravvivenza sono poche e limitate al breve termine. Obiettivo: stabilire se l’AMSA possa essere usata per stratificare il rischio di morte o di outcome neurologico sfavorevole a 30 giorni e ad un anno dall’arresto cardiaco extra ospedaliero (OHCA) dei pazienti con un iniziale ritmo defibrillabile o che si sono convertiti ad esso partendo da un ritmo non defibrillabile. Materiali e metodi: questo è uno studio multicentrico basato sull’analisi retrospettiva di dati prospettici tratti da due registri europei (basati sul modello Utstein) degli OHCAs. Sono stati considerati tutti i pazienti con OHCA che abbiano ricevuto almeno una defibrillazione manuale. I valori di AMSA sono stati calcolati partendo dai dati estratti dai monitors/defibrillatori usati sul territorio considerando un intervallo pre-shock di 2 secondi. Il primo valore di AMSA registrato, il massimo, il minimo e il valore medio sono stati calcolati e confrontati in termini di accuratezza nella predizione dell’outcome. Risultati: dei 578 pazienti inclusi, 504 sono morti o hanno avuto un outcome neurologico sfavorevole. Tutti i valori di AMSA considerati erano significativamente più alti nei sopravvissuti con un buon outcome neurologico, e il valore medio di AMSA ha mostrato la più alta Area Sotto la Curva ROC [0.778, (95%CI: 0.74-0.81), p<0.01]. Correggendo per i confondenti, si è visto che i terzili più alti (T3 e T2) del valore medio di AMSA erano significativamente associati ad un rischio più basso di morte o outcome neurologico sfavorevole rispetto al primo terzile sia a 30 giorni [T2: HR 0.7 (95%CI 0.5-0.9), p =0.003; T3: HR 0.6 (95%CI 0.4-0.7), p<0.001] che ad un anno [T2: HR 0.6 (95%CI 0.4-0.9), p =0.005; T3: HR 0.5 (95%CI 0.4-0.8), p<0.003]. Inoltre, tra i sopravvissuti a 30 giorni, il più basso valore di AMSA medio è risultato al rischio di morte o outcome neurologico sfavorevole ad un anno [T2: HR 0.1 (95%CI 0.1-0.9), p =0.04; T3: HR 0.01 (95%CI 0.-0.3), p=0.005]. Conclusioni: l’AMSA è significativamente e indipendentemente associato con il rischio di morte o outcome neurologico sfavorevole a 30 giorni e ad un anno nei pazienti con arresto extraospedaliero. Tra i valori di AMSA considerati, il valore medio è quello che si associa più strettamente con la prognosi.
ASSOCIAZIONE TRA ANALISI SPETTRALE DELLA FIBRILLAZIONE VENTRICOLARE E OUTCOME CLINICO DOPO ARRESTO CARDIACO EXTRA OSPEDALIERO
FERUGLIO, CHIARA
2022/2023
Abstract
Background: Amplitude spectral area (AMSA) of ventricular fibrillation (VF) is a surrogate for the metabolic status of the heart and is able to predict shock success and return of a spontaneous circulation (ROSC). There is very little evidence, and limited to short-term outcome, of the association between Amplitude Spectral Area (AMSA) of ventricular fibrillation and survival after Out-of-Hospital Cardiac Arrest (OHCA). Purpose: we aimed to assess whether AMSA could stratify the risk of death or poor neurological outcome in patients with initial shockable rhythm or initial non-shockable rhythm with conversion to a shockable one, both at 30 days and at one year from OHCA. Methods: this is a multicentre study based on retrospective analysis of prospectively collected data in two European Utstein based OHCA registries. We included all OHCAs with at least one manual defibrillation. AMSA values were calculated after data extraction from the monitors/defibrillators used in the field by using a 2-second-pre-shock electrocardiogram interval. The first AMSA detected, the maximum, the average and the minimum values were computed and their outcome prediction accuracy was compared. Results: Of the 578 patients included 504 died or had a poor neurological outcome. All the AMSA values considered were significantly higher in survivors with good neurological outcome, and the average AMSA showed the highest Area Under the ROC Curve [0.778, (95%CI: 0.74-0.81), p<0.01]. After correction for confounders the highest tertiles of average AMSA (T3 and T2) were significantly associated with a lower risk of death or poor neurological outcome compared to T1 both at 30 days [T2: HR 0.7 (95%CI 0.5-0.9), p =0.003; T3: HR 0.6 (95%CI 0.4-0.7), p<0.001] and at one year [T2: HR 0.6 (95%CI 0.4-0.9), p =0.005; T3: HR 0.5 (95%CI 0.4-0.8), p<0.003]. Moreover, among survivors at 30 days, lower AMSA was associated with mortality or poor neurological outcome at one year [T2: HR 0.1 (95%CI 0.1-0.9), p =0.04; T3: HR 0.01 (95%CI 0.-0.3), p=0.005]. Conclusion: AMSA was significantly and independently associated with the risk of death or poor neurological outcome at 30 days and at 1 year in OHCA patients. The average AMSA had the closest association with prognosis.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
Per maggiori informazioni e per verifiche sull'eventuale disponibilità del file scrivere a: unitesi@unipv.it.
https://hdl.handle.net/20.500.14239/15998