Amplitude spectrum area to guide resuscitation—A retrospective analysis during out-of-hospital cardiopulmonary resuscitation in 609 patients with ventricular fibrillation cardiac arrest

IntroductionThe capability of amplitude spectrum area (AMSA) to predict the success of defibrillation (DF) was retrospectively evaluated in a large database of out-of-hospital cardiac arrests.MethodsElectrocardiographic data, including 1260 DFs, were obtained from 609 cardiac arrest patients due to ventricular fibrillation. AMSA sensitivity, specificity, accuracy, and positive and negative predictive values (PPV, NPV) for predicting DF success were calculated, together with receiver operating characteristic (ROC) curves. Successful DF was defined as the presence of spontaneous rhythm ≥40 bpm starting within 60 s from the DF. In 303 patients with chest compression (CC) depth data collected with an accelerometer, changes in AMSA were analyzed in relationship to CC depth.ResultsAMSA was significantly higher prior to a successful DF than prior to an unsuccessful DF (15.6 ± 0.6 vs. 7.97 ± 0.2 mV-Hz, p < 0.0001). Intersection of sensitivity, specificity and accuracy curves identified a threshold AMSA of 10 mV-Hz to predict DF success with a balanced sensitivity, specificity and accuracy of almost 80%. Higher AMSA thresholds were associated with further increases in accuracy, specificity and PPV. AMSA of 17 mV-Hz predicted DF success in two third of instances (PPV of 67%). Low AMSA, instead, predicted unsuccessful DFs with high sensitivity and NPV >97%. Area under the ROC curve was 0.84. CC depth affected AMSA value. When depth was <1.75 in., AMSA decreased for consecutive DFs, while it increased when the depth was >1.75 in. (p < 0.05).ConclusionsAMSA could be a useful tool to guide CPR interventions and predict the optimal timing of DF.