Currently, CPR interventions are delivered according to guidelines-driven protocols. These protocols lack flexibility to adapt to specific features of the victim and to changing physiologic conditions as the CPR effort progresses. Thus, CPR is delivered in a highly prescriptive manner without capability for tailoring interventions.
We have shown at the Resuscitation Institute in a swine model of ventricular fibrillation (VF), that delivering electrical shocks according to the probability of shock success based on real-time analysis of the VF amplitude spectral area (AMSA) is superior to a guidelines-driven protocol. With the AMSA-driven protocol, the burden of unsuccessful shocks is reduced leading to better post-resuscitation myocardial function and improved short-term survival.1
Adjusting the depth of chest compression according to real-time assessment of forward blood flow generation is another example of multiple opportunities for a tailored resuscitation effort.2
- Aiello S, Perez M, Cogan C, Baetiong A, Miller SA, Radhakrishnan J, Kaufman CL, Gazmuri RJ. Real-Time Ventricular Fibrillation Amplitude-Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine. J Am Heart Assoc. 2017 Nov 4;6(11):e006749.
- Trivedi K, Borovnik-Lesjak V, Gazmuri RJ. LUCAS 2™ device, compression depth, and the 2010 cardiopulmonary resuscitation guidelines. Am J Emerg Med. 2013 Jul;31(7):1154.e1-2.
We are currently studying whether AMSA-driven resuscitation could also guide more precise use of epinephrine and thus improve outcome by reducing both, shock and adrenergic burden.