Abstract
Optimal defibrillation timing guided by ventricular fibrillation (VF) waveform analysis would contribute to improved survival of out-of-hospital cardiac arrest (OHCA) patients by minimizing myocardial damage caused by futile defibrillation shocks and minimizing interruptions to cardiopulmonary resuscitation. Recently, fuzzy entropy (FuzzyEn) tailored to jointly measure VF amplitude and regularity has been shown to be an efficient defibrillation success predictor. In this study, 734 shocks from 296 OHCA patients (50 survivors) were analyzed, and the embedding dimension (m) and matching tolerance (r) for FuzzyEn and sample entropy (SampEn) were adjusted to predict defibrillation success and patient survival. Entropies were significantly larger in successful shocks and in survivors, and when compared to the available methods, FuzzyEn presented the best prediction results, marginally outperforming SampEn. The sensitivity and specificity of FuzzyEn were 83.3% and 76.7% when predicting defibrillation success, and 83.7% and 73.5% for patient survival. Sensitivities and specificities were two points above those of the best available methods, and the prediction accuracy was kept even for VF intervals as short as 2s. These results suggest that FuzzyEn and SampEn may be promising tools for optimizing the defibrillation time and predicting patient survival in OHCA patients presenting VF.
Highlights
Out-of-hospital cardiac arrest (OHCA) is a major health problem
Our results show that sample entropy (SampEn) and fuzzy entropy (FuzzyEn) outperform the rest of the predictors proposed to date, and that entropies should be parametrized differently depending on the criterion used for shock success
This registry data is routinely compiled in the standard cardiac arrest reporting format (Utstein style) [47], and includes information from the emergency medical system’s coordination centers, ambulances, and hospitals, and follow-up information about the patients discharged alive from hospital
Summary
Out-of-hospital cardiac arrest (OHCA) is a major health problem. Cardiac arrest is characterized by the sudden and unexpected interruption of the mechanical activity of the heart and of spontaneous breathing. This cessation of oxygen transport to the vital organs, especially to the brain, causes death within a few minutes. The most common arrhythmia causing OHCA is ventricular fibrillation (VF) [3], a non-perfusing rhythm characterized by rapid and Entropy 2018, 20, 591; doi:10.3390/e20080591 www.mdpi.com/journal/entropy. Entropy 2018, 20, 591 chaotic electrical impulses, causing uncoordinated contraction of the ventricles, the main pumping chambers of the heart. The only effective way to revert VF and restore spontaneous circulation (ROSC)
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