Article ; Online: Prediction of Shock-Refractory Ventricular Fibrillation During Resuscitation of Out-of-Hospital Cardiac Arrest.
2023 Volume 148, Issue 4, Page(s) 327–335
Abstract: Background: Out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation (VF) is associated with relatively poor survival. The ability to predict refractory VF (requiring ≥3 shocks) in advance of repeated shock failure could enable ... ...
| Abstract | Background: Out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation (VF) is associated with relatively poor survival. The ability to predict refractory VF (requiring ≥3 shocks) in advance of repeated shock failure could enable preemptive targeted interventions aimed at improving outcome, such as earlier administration of antiarrhythmics, reconsideration of epinephrine use or dosage, changes in shock delivery strategy, or expedited invasive treatments. Methods: We conducted a cohort study of VF out-of-hospital cardiac arrest to develop an ECG-based algorithm to predict patients with refractory VF. Patients with available defibrillator recordings were randomized 80%/20% into training/test groups. A random forest classifier applied to 3-s ECG segments immediately before and 1 minute after the initial shock during cardiopulmonary resuscitation was used to predict the need for ≥3 shocks based on singular value decompositions of ECG wavelet transforms. Performance was quantified by area under the receiver operating characteristic curve. Results: Of 1376 patients with VF out-of-hospital cardiac arrest, 311 (23%) were female, 864 (63%) experienced refractory VF, and 591 (43%) achieved functional neurological survival. Total shock count was associated with decreasing likelihood of functional neurological survival, with a relative risk of 0.95 (95% CI, 0.93-0.97) for each successive shock ( Conclusions: A machine learning algorithm using ECGs surrounding the initial shock predicts patients likely to experience refractory VF, and could enable rescuers to preemptively target interventions to potentially improve resuscitation outcome. |
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| MeSH term(s) | Humans ; Female ; Male ; Out-of-Hospital Cardiac Arrest/diagnosis ; Out-of-Hospital Cardiac Arrest/therapy ; Out-of-Hospital Cardiac Arrest/complications ; Electric Countershock/adverse effects ; Ventricular Fibrillation/diagnosis ; Ventricular Fibrillation/therapy ; Ventricular Fibrillation/complications ; Cohort Studies ; Cardiopulmonary Resuscitation/adverse effects |
| Language | English |
| Publishing date | 2023-06-02 |
| Publishing country | United States |
| Document type | Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 80099-5 |
| ISSN | 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499 |
| ISSN (online) | 1524-4539 |
| ISSN | 0009-7322 ; 0069-4193 ; 0065-8499 |
| DOI | 10.1161/CIRCULATIONAHA.122.063651 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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