Signal integral for optimizing the timing of defibrillation

Objective: The possibility of successful defibrillation decreases with an increased duration of ventricular fibrillation (VF). Futile electrical shocks are inversely correlated with myocardial contractile function and long-term survival. Previous studies have demonstrated that various ECG waveform analyses predict the success of defibrillation. This study investigated whether the absolute amplitude of pre-shock VF waveform is likely to predict the success of defibrillation. Methods: ECG recordings of 350 out-of-hospital cardiac arrest (OOHCA) patients were obtained from the automated external defibrillator (AED) and analyzed by the method of signal integral. Successful defibrillation was defined as organized rhythm with heart rate >= 40 beat/min commencing within one min of post-shock period and persisting for a minimum of 30s. Results: Signal integral was significantly greater in successful defibrillation than unsuccessful defibrillation (81.76 +/- 32.3 mV vs. 34.9 +/- 15.33 mV, p < 0.001). The intersection of the sensitivity and specificity curve provided a threshold value of 51 mV. The corresponding values of sensitivity, specificity, positive predictive and negative predictive values for successful defibrillation were 90%, 86%, 80% and 93%, respectively. The receiver operator curve further revealed that signal integral predicted the likelihood of successful defibrillation (area under the curve = 0.949). Conclusions: Signal integral predicted successful electrical shocks on patients with ventricular fibrillation and have potential to optimize the timing of defibrillation and reduce the number of electrical shocks. (C) 2013 Elsevier Ireland Ltd. All rights reserved.