TY - JOUR
T1 - The effect of the localisation of an underlying ST-elevation myocardial infarction on the VF-waveform: A multi-centre cardiac arrest study
T2 - A multi-centre cardiac arrest study
AU - Nas, J.
AU - van Dongen, L. H.
AU - Thannhauser, J.
AU - Hulleman, M.
AU - van Royen, N.
AU - Tan, H. L.
AU - Bonnes, J. L.
AU - Koster, R. W.
AU - Brouwer, M. A.
AU - Blom, M. T.
N1 - Funding Information: MTB, HLT and LvD were supported by the European Union's Horizon 2020 research and innovation program under acronym ESCAPE-NET , registered under grant agreement No 733381 , and the COST Action PARQ (grant agreement No CA19137 ) supported by COST (European Cooperation in Science and Technology), and the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centers, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (LvD, HLT), and CVON2018-30 Predict2 (MTB, HLT). The ARREST registry is supported by an unconditional grant of Stryker, Emergency Care, Redmond, WA USA. The funders had no access to the data and did not contribute to the preparation of this manuscript. Funding Information: The authors thank N.F. Khelil, R. Stieglis, V.G.M. van Eeden, and M.M. Ekkel for data management. Moreover, the authors are greatly thankful to all the students for collecting data, the participation of all EMS dispatch centres (Amsterdam, Haarlem, Alkmaar), regional ambulance services (Ambulance Amsterdam, GGD Kennemerland, Witte Kruis, Ambulancezorg Veiligheidsregio Noord-Holland Noord), fire brigades, and police departments, as well the hospitals in the study regions. MTB, HLT and LvD were supported by the European Union's Horizon 2020 research and innovation program under acronym ESCAPE-NET, registered under grant agreement No 733381, and the COST Action PARQ (grant agreement No CA19137) supported by COST (European Cooperation in Science and Technology), and the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centers, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (LvD, HLT), and CVON2018-30 Predict2 (MTB, HLT). The ARREST registry is supported by an unconditional grant of Stryker, Emergency Care, Redmond, WA USA. The funders had no access to the data and did not contribute to the preparation of this manuscript. Publisher Copyright: © 2021 The Authors
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Introduction: In cardiac arrest, ventricular fibrillation (VF) waveform characteristics such as amplitude spectrum area (AMSA) are studied to identify an underlying myocardial infarction (MI). Observational studies report lower AMSA-values in patients with than without underlying MI. Moreover, experimental studies with 12-lead ECG-recordings show lowest VF-characteristics when the MI-localisation matches the ECG-recording direction. However, out-of-hospital cardiac arrest (OHCA)-studies with defibrillator-derived VF-recordings are lacking. Methods: Multi-centre (Amsterdam/Nijmegen, the Netherlands) cohort-study on the association between AMSA, ST-elevation MI (STEMI) and its localisation. AMSA was calculated from defibrillator pad-ECG recordings (proxy for lead II, inferior vantage point); STEMI-localisation was determined using ECG/angiography/autopsy findings. Results: We studied AMSA-values in 754 OHCA-patients. There were statistically significant differences between no STEMI, anterior STEMI and inferior STEMI (Nijmegen: no STEMI 13.0mVHz [7.9–18.6], anterior STEMI 7.5mVHz [5.6–13.8], inferior STEMI 7.5mVHz [5.4–11.8], p = 0.006. Amsterdam: 11.7mVHz [5.0–21.9], 9.6mVHz [4.6–17.2], and 6.9mVHz [3.2–16.0], respectively, p = 0.001). Univariate analyses showed significantly lower AMSA-values in inferior STEMI vs. no STEMI; there was no significant difference between anterior and no STEMI. After correction for confounders, adjusted absolute AMSA-values were numerically lowest for inferior STEMI in both cohorts, and the relative differences in AMSA between inferior and no STEMI was 1.4–1.7 times larger than between anterior and no STEMI. Conclusion: This multi-centre VF-waveform OHCA-study showed significantly lower AMSA in case of underlying STEMI, with a more pronounced difference for inferior than for anterior STEMI. Confirmative studies on the impact of STEMI-localisation on the VF-waveform are warranted, and might contribute to earlier diagnosis of STEMI during VF.
AB - Introduction: In cardiac arrest, ventricular fibrillation (VF) waveform characteristics such as amplitude spectrum area (AMSA) are studied to identify an underlying myocardial infarction (MI). Observational studies report lower AMSA-values in patients with than without underlying MI. Moreover, experimental studies with 12-lead ECG-recordings show lowest VF-characteristics when the MI-localisation matches the ECG-recording direction. However, out-of-hospital cardiac arrest (OHCA)-studies with defibrillator-derived VF-recordings are lacking. Methods: Multi-centre (Amsterdam/Nijmegen, the Netherlands) cohort-study on the association between AMSA, ST-elevation MI (STEMI) and its localisation. AMSA was calculated from defibrillator pad-ECG recordings (proxy for lead II, inferior vantage point); STEMI-localisation was determined using ECG/angiography/autopsy findings. Results: We studied AMSA-values in 754 OHCA-patients. There were statistically significant differences between no STEMI, anterior STEMI and inferior STEMI (Nijmegen: no STEMI 13.0mVHz [7.9–18.6], anterior STEMI 7.5mVHz [5.6–13.8], inferior STEMI 7.5mVHz [5.4–11.8], p = 0.006. Amsterdam: 11.7mVHz [5.0–21.9], 9.6mVHz [4.6–17.2], and 6.9mVHz [3.2–16.0], respectively, p = 0.001). Univariate analyses showed significantly lower AMSA-values in inferior STEMI vs. no STEMI; there was no significant difference between anterior and no STEMI. After correction for confounders, adjusted absolute AMSA-values were numerically lowest for inferior STEMI in both cohorts, and the relative differences in AMSA between inferior and no STEMI was 1.4–1.7 times larger than between anterior and no STEMI. Conclusion: This multi-centre VF-waveform OHCA-study showed significantly lower AMSA in case of underlying STEMI, with a more pronounced difference for inferior than for anterior STEMI. Confirmative studies on the impact of STEMI-localisation on the VF-waveform are warranted, and might contribute to earlier diagnosis of STEMI during VF.
KW - Out-of-hospital cardiac arrest
KW - ST-elevation myocardial infarction
KW - Ventricular fibrillation
KW - Waveform analysis
UR - http://www.scopus.com/inward/record.url?scp=85115053604&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.resuscitation.2021.08.049
DO - https://doi.org/10.1016/j.resuscitation.2021.08.049
M3 - Article
C2 - 34500021
SN - 0300-9572
VL - 168
SP - 11
EP - 18
JO - Resuscitation
JF - Resuscitation
ER -