Abstract 368: Does Filtered Rhythm Technology Lead to Increased Inappropriate Manual Defibrillation?

Abstract

Introduction: Defibrillation of ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) is an effective treatment for patients with cardiac arrest (CA). Identifying the rhythm during cardiopulmonary resuscitation (CPR) can be difficult with the rhythm obscured by chest compression artifact. “Rhythm” checks are usually recommended, but this interrupts the resuscitation attempt. Filtered rhythm technology such as See-Thru CPR aims to reduce these interruptions by filtering out chest compression artifact, leading to easier visualization of the underlying heart rhythm without stopping CPR. Hypothesis: While See-Thru CPR is effective at improving chest compression fraction, inappropriate shocks of non-VF/VT rhythms are still common. Methods: This is a retrospective review of an internal database of all cardiac arrests occurring within a two-hospital academic hospital system between July 2012 and September 2019. The local CPR algorithm trains responders to utilize See-Thru CPR to minimize interruptions and increase the chest compression fraction (the average chest compression fraction is > 90%). The database includes all inpatient and emergency room CA and includes patient demographics, cardiac and resuscitation data including CPR parameter data when available, and outcomes. Cardiac arrests with CPR data were reviewed and all defibrillation attempts were identified and analyzed. Pre and post-shock rhythm were identified by reviewing the preceding rhythm strip, and the rhythm following the defibrillation delivery. Results: Three hundred thirty-six patients had CA with complete CPR data containing defibrillation attempts. These 336 patients had 1199 defibrillations delivered. Between 1 - 39 shocks were delivered during each event. The majority of defibrillations were delivered correctly for VF/VT (916/1199, 76%), however 23.6% of defibrillations were inappropriate - PEA in 232 attempts (19%) and asystole in 51 (4%). Of these inappropriate shocks, 23 converted to either VF/VT or ROSC, while the rest maintained a non-VF/VT rhythm. Conclusions: Defibrillation while using See-Thru CPR for inappropriate shocks is common. Further studies will be needed to show the clinical effects of shocking non-VF/VT rhythms.