• Giuseppe Ristagno, Tommaso Mauri, Giancarlo Cesana, Yongqin Li, Andrea Finzi, Francesca Fumagalli, Gianpiera Rossi, Niccolò Grieco, Maurizio Migliori, Aida Andreassi, Roberto Latini, Carla Fornari, Antonio Pesenti, and Azienda Regionale Emergenza Urgenza Research Group.
• From the IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (G.R., A.F., F.F., R.L.); Department of Anesthesia and Intensive Care, San Gerardo Hospital, Monza, and University of Milano-Bicocca, Milan, Italy (T.M., G.R., A.P.); Research Center on Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy (G.C., C.F.); School of Biomedical Engineering, Third Military Medical University and Chongqing University, Chongqing, China (Y.L.); and Azienda Regionale Emergenza Urgenza (AREU), Milan, Italy (G.R., N.G., M.M., A.A., A.P.). gristag@gmail.com.
• Circulation. 2015 Feb 3;131(5):478-87.

BackgroundThis study sought to validate the ability of amplitude spectrum area (AMSA) to predict defibrillation success and long-term survival in a large population of out-of-hospital cardiac arrests.Methods And ResultsECGs recorded by automated external defibrillators from different manufacturers were obtained from patients with cardiac arrests occurring in 8 city areas. A database, including 2447 defibrillations from 1050 patients, was used as the derivation group, and an additional database, including 1381 defibrillations from 567 patients, served as validation. A 2-second ECG window before defibrillation was analyzed, and AMSA was calculated. Univariable and multivariable regression analyses and area under the receiver operating characteristic curve were used for associations between AMSA and study end points: defibrillation success, sustained return of spontaneous circulation, and long-term survival. Among the 2447 defibrillations of the derivation database, 26.2% were successful. AMSA was significantly higher before a successful defibrillation than a failing one (13 ± 5 versus 6.8 ± 3.5 mV-Hz) and was an independent predictor of defibrillation success (odds ratio, 1.33; 95% confidence interval, 1.20-1.37) and sustained return of spontaneous circulation (odds ratio, 1.22; 95% confidence interval, 1.17-1.26). Area under the receiver operating characteristic curve for defibrillation success prediction was 0.86 (95% confidence interval, 0.85-0.88). AMSA was also significantly associated with long-term survival. The following AMSA thresholds were identified: 15.5 mV-Hz for defibrillation success and 6.5 mV-Hz for defibrillation failure. In the validation database, AMSA ≥ 15.5 mV-Hz had a positive predictive value of 84%, whereas AMSA ≤ 6.5 mV-Hz had a negative predictive value of 98%.ConclusionsIn this large derivation-validation study, AMSA was validated as an accurate predictor of defibrillation success. AMSA also appeared as a predictor of long-term survival.© 2014 American Heart Association, Inc.

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