Precountershock cardiopulmonary resuscitation improves ventricular fibrillation median frequency and myocardial readiness for successful defibrillation from prolonged ventricular fibrillation

A randomized, controlled swine study

Robert Allen Berg, Ronald Willard Hilwig, Karl B Kern, Gordon A. Ewy

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Study objective: After prolonged ventricular fibrillation (VF), precountershock cardiopulmonary resuscitation (CPR) will improve myocardial "readiness" for defibrillation compared with immediate defibrillation. Methods: After 10 minutes of untreated VF, 32 swine (27±1 kg) were randomly assigned to receive immediate countershocks (DEFIB), CPR for 3 minutes followed by countershocks (CPR), or CPR for 3 minutes plus intravenous epinephrine followed by countershocks (CPR+EPI). VF waveform was evaluated by fast Fourier transformation. Results: VF amplitude and median frequency by fast Fourier transformation decreased during the untreated VF interval in all groups, and the median frequency subsequently increased during each minute of precountershock CPR. Although the VF median frequency in the 3 groups did not differ after 10 minutes of untreated VF (8.9±0.8 Hz versus 8.4±0.5 Hz versus 7.3±0.5 Hz, respectively), immediately before the first shock the VF median frequency was much lower in the DEFIB group than in either the CPR or CPR+EPI groups (8.9±0.8 Hz versus 13.1±0.8 Hz versus 13.8±0.9 Hz, respectively; P<.01). None of the 10 animals in the DEFIB group attained return of spontaneous circulation after the first set of shocks versus 5 of 10 animals in the CPR group and 6 of 12 animals in the CPR+EPI group (DEFIB versus each CPR group; P<.05). Cardiac output 1 hour after resuscitation was substantially worse in the DEFIB group than in the CPR or CPR+EPI groups (74±7 mL/kg per minute versus 119±7 mL/kg per minute versus 104±15 mL/kg per minute; P<.05). Conclusion: Precountershock CPR can result in substantial physiologic benefits compared with immediate defibrillation in the setting of prolonged VF. Moreover, these benefits can be attained with or without the addition of intravenous epinephrine.

Original languageEnglish (US)
Pages (from-to)563-570
Number of pages8
JournalAnnals of Emergency Medicine
Volume40
Issue number6
DOIs
StatePublished - Dec 1 2002

Fingerprint

Cardiopulmonary Resuscitation
Ventricular Fibrillation
Swine
Epinephrine
Shock
Resuscitation
Cardiac Output

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{fc93b9ffb08e433f8673ceba8e3f802b,
title = "Precountershock cardiopulmonary resuscitation improves ventricular fibrillation median frequency and myocardial readiness for successful defibrillation from prolonged ventricular fibrillation: A randomized, controlled swine study",
abstract = "Study objective: After prolonged ventricular fibrillation (VF), precountershock cardiopulmonary resuscitation (CPR) will improve myocardial {"}readiness{"} for defibrillation compared with immediate defibrillation. Methods: After 10 minutes of untreated VF, 32 swine (27±1 kg) were randomly assigned to receive immediate countershocks (DEFIB), CPR for 3 minutes followed by countershocks (CPR), or CPR for 3 minutes plus intravenous epinephrine followed by countershocks (CPR+EPI). VF waveform was evaluated by fast Fourier transformation. Results: VF amplitude and median frequency by fast Fourier transformation decreased during the untreated VF interval in all groups, and the median frequency subsequently increased during each minute of precountershock CPR. Although the VF median frequency in the 3 groups did not differ after 10 minutes of untreated VF (8.9±0.8 Hz versus 8.4±0.5 Hz versus 7.3±0.5 Hz, respectively), immediately before the first shock the VF median frequency was much lower in the DEFIB group than in either the CPR or CPR+EPI groups (8.9±0.8 Hz versus 13.1±0.8 Hz versus 13.8±0.9 Hz, respectively; P<.01). None of the 10 animals in the DEFIB group attained return of spontaneous circulation after the first set of shocks versus 5 of 10 animals in the CPR group and 6 of 12 animals in the CPR+EPI group (DEFIB versus each CPR group; P<.05). Cardiac output 1 hour after resuscitation was substantially worse in the DEFIB group than in the CPR or CPR+EPI groups (74±7 mL/kg per minute versus 119±7 mL/kg per minute versus 104±15 mL/kg per minute; P<.05). Conclusion: Precountershock CPR can result in substantial physiologic benefits compared with immediate defibrillation in the setting of prolonged VF. Moreover, these benefits can be attained with or without the addition of intravenous epinephrine.",
author = "Berg, {Robert Allen} and Hilwig, {Ronald Willard} and Kern, {Karl B} and Ewy, {Gordon A.}",
year = "2002",
month = "12",
day = "1",
doi = "10.1067/mem.2002.129866",
language = "English (US)",
volume = "40",
pages = "563--570",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Precountershock cardiopulmonary resuscitation improves ventricular fibrillation median frequency and myocardial readiness for successful defibrillation from prolonged ventricular fibrillation

T2 - A randomized, controlled swine study

AU - Berg, Robert Allen

AU - Hilwig, Ronald Willard

AU - Kern, Karl B

AU - Ewy, Gordon A.

PY - 2002/12/1

Y1 - 2002/12/1

N2 - Study objective: After prolonged ventricular fibrillation (VF), precountershock cardiopulmonary resuscitation (CPR) will improve myocardial "readiness" for defibrillation compared with immediate defibrillation. Methods: After 10 minutes of untreated VF, 32 swine (27±1 kg) were randomly assigned to receive immediate countershocks (DEFIB), CPR for 3 minutes followed by countershocks (CPR), or CPR for 3 minutes plus intravenous epinephrine followed by countershocks (CPR+EPI). VF waveform was evaluated by fast Fourier transformation. Results: VF amplitude and median frequency by fast Fourier transformation decreased during the untreated VF interval in all groups, and the median frequency subsequently increased during each minute of precountershock CPR. Although the VF median frequency in the 3 groups did not differ after 10 minutes of untreated VF (8.9±0.8 Hz versus 8.4±0.5 Hz versus 7.3±0.5 Hz, respectively), immediately before the first shock the VF median frequency was much lower in the DEFIB group than in either the CPR or CPR+EPI groups (8.9±0.8 Hz versus 13.1±0.8 Hz versus 13.8±0.9 Hz, respectively; P<.01). None of the 10 animals in the DEFIB group attained return of spontaneous circulation after the first set of shocks versus 5 of 10 animals in the CPR group and 6 of 12 animals in the CPR+EPI group (DEFIB versus each CPR group; P<.05). Cardiac output 1 hour after resuscitation was substantially worse in the DEFIB group than in the CPR or CPR+EPI groups (74±7 mL/kg per minute versus 119±7 mL/kg per minute versus 104±15 mL/kg per minute; P<.05). Conclusion: Precountershock CPR can result in substantial physiologic benefits compared with immediate defibrillation in the setting of prolonged VF. Moreover, these benefits can be attained with or without the addition of intravenous epinephrine.

AB - Study objective: After prolonged ventricular fibrillation (VF), precountershock cardiopulmonary resuscitation (CPR) will improve myocardial "readiness" for defibrillation compared with immediate defibrillation. Methods: After 10 minutes of untreated VF, 32 swine (27±1 kg) were randomly assigned to receive immediate countershocks (DEFIB), CPR for 3 minutes followed by countershocks (CPR), or CPR for 3 minutes plus intravenous epinephrine followed by countershocks (CPR+EPI). VF waveform was evaluated by fast Fourier transformation. Results: VF amplitude and median frequency by fast Fourier transformation decreased during the untreated VF interval in all groups, and the median frequency subsequently increased during each minute of precountershock CPR. Although the VF median frequency in the 3 groups did not differ after 10 minutes of untreated VF (8.9±0.8 Hz versus 8.4±0.5 Hz versus 7.3±0.5 Hz, respectively), immediately before the first shock the VF median frequency was much lower in the DEFIB group than in either the CPR or CPR+EPI groups (8.9±0.8 Hz versus 13.1±0.8 Hz versus 13.8±0.9 Hz, respectively; P<.01). None of the 10 animals in the DEFIB group attained return of spontaneous circulation after the first set of shocks versus 5 of 10 animals in the CPR group and 6 of 12 animals in the CPR+EPI group (DEFIB versus each CPR group; P<.05). Cardiac output 1 hour after resuscitation was substantially worse in the DEFIB group than in the CPR or CPR+EPI groups (74±7 mL/kg per minute versus 119±7 mL/kg per minute versus 104±15 mL/kg per minute; P<.05). Conclusion: Precountershock CPR can result in substantial physiologic benefits compared with immediate defibrillation in the setting of prolonged VF. Moreover, these benefits can be attained with or without the addition of intravenous epinephrine.

UR - http://www.scopus.com/inward/record.url?scp=0036898624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036898624&partnerID=8YFLogxK

U2 - 10.1067/mem.2002.129866

DO - 10.1067/mem.2002.129866

M3 - Article

VL - 40

SP - 563

EP - 570

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 6

ER -