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Ventricular Fibrillation Recurrences in Successfully Shocked Out-Of-Hospital Cardiac Arrests

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Ventricular Fibrillation Recurrences in Successfully Shocked Out-Of-Hospital Cardiac Arrests medicina Article Ventricular Fibrillation Recurrences in Successfully Shocked Out-of-Hospital Cardiac Arrests Daniela Aschieri 1 , Federico Guerra 2,* , Valentina Pelizzoni 3, Enrico Paolini 4, Giulia Stronati 2, Luca Moderato 3 , Giulia Losi 1, Paolo Compagnucci 2 , Michela Coccia 1 , Michela Casella 5, Antonio Dello Russo 2, Gust H. Bardy 6 and Alessandro Capucci 2 1 Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; [email protected] (D.A.); [email protected] (G.L.); [email protected] (M.C.) 2 Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; [email protected] (G.S.); [email protected] (P.C.); [email protected] (A.D.R.); [email protected] (A.C.) 3 Cardiology Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy; [email protected] (V.P.); [email protected] (L.M.) 4 Cardiology Department, “Ospedali Riuniti Marche Nord”, 61121 Pesaro, Italy; [email protected] 5 Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; [email protected] 6 Seattle Institute for Cardiac Research, Seattle, WA 98195, USA; [email protected] * Correspondence: [email protected] Abstract: Background and Objectives: The prognostic impact of ventricular fibrillation (VF) recurrences Citation: Aschieri, D.; Guerra, F.; after a successful shock in out-of-hospital cardiac arrest (OOHCA) is still poorly understood, and Pelizzoni, V.; Paolini, E.; Stronati, G.; some evidence suggests a potential pro-arrhythmic effect of chest compressions in this setting. In the Moderato, L.; Losi, G.; Compagnucci, present analysis, we looked at the short-term and long-term prognosis of VF recurrences in OOHCA. P.; Coccia, M.; Casella, M.; et al. And their potential association with chest compressions. Materials and Methods: The Progetto Vita, Ventricular Fibrillation Recurrences in prospectively collecting data on all resuscitation efforts in the Piacenza province (Italy), was used Successfully Shocked Out-of-Hospital Cardiac Arrests. Medicina 2021, 57, for the present analysis. From the 461 OOHCAs found in a shockable rhythm, only those with 358. https://doi.org/10.3390/ optimal ECG tracings and good audio recordings (160) were assessed. Rhythms other than VF post- medicina57040358 shock were analyzed five seconds after shock delivery and survival to hospital admission, hospital discharge, and long-term survival data over a 14-year follow-up were collected. Results: Population Academic Editor: Giuseppe Andò mean age was 64.4 ± 16.9 years, and 31.9% of all patients were female. Mean time to EMS arrival was 5.9 ± 4.5 min. Short- and long-term survival without neurological impairment were higher in Received: 30 January 2021 patients without VF recurrence when compared to patients with VF recurrence, independently from Accepted: 5 April 2021 the pre-induction rhythm (p < 0.001). After shock delivery, VF recurrence was higher when chest Published: 7 April 2021 compressions were resumed early after discharge and more vigorously. Conclusions: VF recurrences after a shock could worsen short and long-term survival. The potential pro-arrhythmic effect of chest Publisher’s Note: MDPI stays neutral compressions should be factored in when considering the real risks and benefits of this procedure. with regard to jurisdictional claims in published maps and institutional affil- Keywords: cardiac arrest; cardiopulmonary resuscitation; chest compressions; sudden cardiac death; iations. ventricular fibrillation; defibrillation Copyright: © 2021 by the authors. 1. Introduction Licensee MDPI, Basel, Switzerland. Cardiopulmonary resuscitation (CPR) is commonly perceived as being beneficial in This article is an open access article distributed under the terms and out-of-hospital cardiac arrest (OOHCA), and the current guidelines recommend prompt conditions of the Creative Commons CPR immediately after defibrillation [1]. Simultaneously, it is well known that a direct, Attribution (CC BY) license (https:// blunt force applied to the chest could also induce ventricular fibrillation and sudden creativecommons.org/licenses/by/ death, in an event called “commotio cordis” [2]. The blow described as the optimal trigger 4.0/). for commotio cordis shares many characteristics with the guideline-advised technique Medicina 2021, 57, 358. https://doi.org/10.3390/medicina57040358 https://www.mdpi.com/journal/medicina Medicina 2021, 57, 358 2 of 8 for chest compressions, [3] which could therefore potentially increase the incidence of Medicina 2021, 57, x FOR PEER REVIEWventricular fibrillation (VF) recurrence after the first effective shock.2 of 9 The incidence of recurrent ventricular fibrillation (VF) varies from 18% to 72% [4,5], and the number of recurrent VF is negatively associated with survival to admission [4]. death, inIn an the event present called analysis“commotio of cordis” the Progetto [2]. The blow Vita described experience as the (www.progetto-vita.eu optimal trigger , accessed foron commotio 18 March cordis 2021), shares we ma examineny characteristics survival with in the a guideline population-advised of OOHCAtechnique for victims in Piacenza, chestItaly compressions, who were found[3] which with could a shockabletherefore potentially rhythm increase and promptly the incidence defibrillated. of ven- We tested the tricular fibrillation (VF) recurrence after the first effective shock. The incidence of recur- renthypothesis ventricularthat fibrillation VF recurrence (VF) varies from could 18% be to 72% associated [4,5], and withthe number a long-term of recurrent survival in OOHCA VFpatients is negatively found associated in a shockable with survival rhythm. to admission We also [4] tested. the hypothesis that chest compressions mayIn bethe associatedpresent analysis with of VFthe recurrence,Progetto Vita experience particularly (www.progetto when they-vita. areeu performed, ac- vigorously cessedand promptlyon 18 March after 2021 a), successfulwe examine shock.survival in a population of OOHCA victims in Piacenza, Italy who were found with a shockable rhythm and promptly defibrillated. We tested2. Materials the hypothesis and that Methods VF recurrence could be associated with a long-term survival in OOHCA patients found in a shockable rhythm. We also tested the hypothesis that chest compressionsThe aim may and be methodologyassociated with ofVF Progetto recurrence, Vita particularly have been when previously they are per- reported [6,7]. In brief, formedall OOHCAs vigorously occurring and promptly in the after city a successful of Piacenza shock. and nearby county were documented according to standard reporting criteria. Transient losses of consciousness, including syncope, were 2. Materials and Methods excluded from the analysis, as were cardiac arrests following administration of cardioactive The aim and methodology of Progetto Vita have been previously reported [6,7]. In brief,medications all OOHCAs during occurring an acutein the city myocardial of Piacenza infarction. and nearby county Survival were to documented hospital admission, survival accordingto hospital to standard discharge, reporting and criteria. long-term Transient survival losses of over consciousness, a 14-year including follow-up syn- was prospectively cope,assessed. were excluded Patient from vital the status analysis, up as until were 1cardiac August arrests 2017, following was validatedadministration for 100% of OOHCA ofvictims cardioactive viathe medications Italian national during an registry acute myocardial of death infarction. and review Survival of medical to hospital records. admission, survival to hospital discharge, and long-term survival over a 14-year follow- up wasFor prospectively the present assessed. analysis, Patient the vital AED status tracingsup until 1 ofAugust all consecutive 2017, was validated patients enrolled from for2001 100% to of 2014 OOHCA into victims the Progetto via the Italian Vita national registry registry and presentingof death and review with aof shockable med- rhythm were icalprospectively records. collected. All analyses were obtained by consensus of two independent in- vestigatorsFor the present experienced analysis, the in analysisAED tracings of cardiacof all consecu rhythmstive patients (E.P. and enrolled F.G.). from ECGs were excluded 2001 to 2014 into the Progetto Vita registry and presenting with a shockable rhythm were prospectivelyfrom the study collected. if tracings All analyses were were incomplete obtained by orconsensus displayed of two sub-optimal independent in- quality, not allowing vestigatorsa clear detection experienced of in cardiac analysis rhythm of cardiac or rhythm chests compression-related (E.P. and F.G.). ECGs were artifacts. ex- cluded Rhythmsfrom the study other if tracings than VF were post-shock incomplete or were displayed analyzed sub-optimal five seconds quality, not after shock delivery allowingand were a clear classified detection as of asystole cardiac rhythm or spontaneous or chest compression electrical-related activity artifacts. (SEA). As the simultaneous presenceRhythms of other a pulse than VF was post obviously-shock wereunknown analyzed five during seconds any after rhythmshock delivery other than VF or asys- and were classified
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