{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T16:41:27Z","timestamp":1764002487454,"version":"3.41.2"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,12,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">We previously reported that resuscitation delivering electrical shocks guided by real\u2010time ventricular fibrillation amplitude spectral area (AMSA) enabled return of spontaneous circulation (ROSC) with fewer shocks, resulting in less myocardial dysfunction. We now hypothesized that AMSA could also guide delivery of epinephrine, expecting further outcome improvement consequent to less electrical and adrenergic burdens.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A swine model of ventricular fibrillation was used to compare after 10\u00a0minutes of untreated ventricular fibrillation a guidelines\u2010driven (n=8) resuscitation protocol, delivering shocks every 2\u00a0minutes and epinephrine every 4\u00a0minutes, with an AMSA\u2010driven shocks (n=8) protocol, delivering epinephrine every 4\u00a0minutes, and with an AMSA\u2010driven shocks and epinephrine (ADSE; n=8) protocol. For guidelines\u2010driven, AMSA\u2010driven shocks, and ADSE protocols, the time to ROSC (mean\u00b1SD) was 569\u00b1164, 410\u00b1111, and 400\u00b180 seconds (\n              <jats:italic>P<\/jats:italic>\n              =0.045); the number of shocks (mean\u00b1SD) was 5\u00b12, 3\u00b11, and 3\u00b12 (\n              <jats:italic>P<\/jats:italic>\n              =0.024) with ADSE fewer than guidelines\u2010driven (\n              <jats:italic>P<\/jats:italic>\n              =0.03); and the doses of epinephrine (median [interquartile range]) were 2.0 (1.3\u20133.0), 1.0 (1.0\u20132.8), and 1.0 (0.3\u20133.0) (\n              <jats:italic>P<\/jats:italic>\n              =0.419). The ROSC rate was similar, yet survival after ROSC favored AMSA\u2010driven protocols (guidelines\u2010driven, 3\/6; AMSA\u2010driven shocks, 6\/6; and ADSE, 7\/7;\n              <jats:italic>P<\/jats:italic>\n              =0.019 by log\u2010rank test). Left ventricular function and survival after ROSC correlated inversely with electrical burden (ie, cumulative unsuccessful shocks, J\/kg;\n              <jats:italic>P<\/jats:italic>\n              =0.020 and\n              <jats:italic>P<\/jats:italic>\n              =0.046) and adrenergic burden (ie, total epinephrine doses, mg\/kg;\n              <jats:italic>P<\/jats:italic>\n              =0.042 and\n              <jats:italic>P<\/jats:italic>\n              =0.002).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Despite similar ROSC rates achieved with all 3 protocols, AMSA\u2010driven shocks and ADSE resulted in less postresuscitation myocardial dysfunction and better survival, attributed to attaining ROSC with less electrical and adrenergic myocardial burdens.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023956","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T10:01:33Z","timestamp":1636365693000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Targeted Delivery of Electrical Shocks and Epinephrine, Guided by Ventricular Fibrillation Amplitude Spectral Area, Reduces Electrical and Adrenergic Myocardial Burden, Improving Survival in Swine"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2324-8768","authenticated-orcid":false,"given":"Salvatore R.","family":"Aiello","sequence":"first","affiliation":[{"name":"Resuscitation InstituteRosalind Franklin University of Medicine and Science North Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna B.","family":"Mendelson","sequence":"additional","affiliation":[{"name":"Resuscitation InstituteRosalind Franklin University of Medicine and Science North Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvin","family":"Baetiong","sequence":"additional","affiliation":[{"name":"Resuscitation InstituteRosalind Franklin University of Medicine and Science North Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeejabai","family":"Radhakrishnan","sequence":"additional","affiliation":[{"name":"Resuscitation InstituteRosalind Franklin University of Medicine and Science North Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3848-7227","authenticated-orcid":false,"given":"Ra\u00fal J.","family":"Gazmuri","sequence":"additional","affiliation":[{"name":"Resuscitation InstituteRosalind Franklin University of Medicine and Science North Chicago IL"},{"name":"Section of Critical Care MedicineCAPT James A. 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