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 We have recently expanded our AMSA-driven protocol to also limit the administration of epinephrine to only when increasing myocardial perfusion is required for successful defibrillation and thereby reducing myocardial adrenergic burden and the consequent adverse post-resuscitation effects.2
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.3
- 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.
- Aiello S, Mendelson JB, Baeting A, Radhakrishnan J, Gazmuri RJ. Targeted delivery of electrical shocks and epinephrine, guided by ventricular fibrillation amplitude spectral area, reduces electrical and adrenergic myocardial burden, improving survival in swine. J Am Heart Assoc 2021;10:e023956. DOI: 10.1161/JAHA.121.023956
- 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.