Assessment of reperfusion following thrombolysis with mean fibrillation and amplitude spectrum area in patients with sustained ventricular fibrillation

Abstract

Background: Improved microcirculatory reperfusion in patients with ventricular fibrillation (VF) enhances the electrical activity of the fibrillation process and increases the likelihood of successful defibrillation.

Methods: Changes in amplitude spectrum area (AMSA) and mean fibrillation (MF) in patients with sustained VF were analysed after administration of rt-PA variant tenecteplase in out-of-hospital cardiac arrest (OHCA) during cardiopulmonary resuscitation (CPR).

Results: A total of 69 ECG sequences from nine patients were evaluated. Patients who received tenecteplase showed significantly longer duration of VF (p = 0.016). While AMSA declined significantly during CPR (p = 0.001), MF did not differ between groups. There were two survivors in the treatment group and one in the control group.

Conclusion: When tenecteplase was administered during CPR, VF lasted significantly longer than in controls. Changes in MF and AMSA did not indicate improved myocardial perfusion in patients who received tenecteplase during CPR.

Keywords:

• Electric counter-shock
• Emergency medical services
• Fast Fourier transformation
• Manual defibrillator
• Out-of-hospital CPR
• Thrombolysis

Acknowledgments

We thank the emergency physicians of Innsbruck Medical University and the emergency technicians of the Austrian Red Cross, Innsbruck district office, for their excellent performance in resuscitation and the TROICA steering group for having given their permit to perform this analysis in a subgroup.

Declaration of interest: The permission for publication was obtained from the TROICA study group and the manuscript was released and approved by Boehringer Ingelheim Corporate. TROICA received support from Boehringer Ingelheim, Germany, the manufacturer of tenecteplase (Metalyse®).

Welsh Allyn (former Medical Research Laboratory, Chicago) supplied EMS Innsbruck with two specially equipped PIC 50 defibrillators during the study period. All work was conducted independently and the supporting parties had no influence on data evaluation and on the decision to publish or not.