Abstract
PurposeAutomated external defibrillators (AED) prompt the rescuer to stop chest compressions (CC) for ECG analysis during out-of-hospital cardiac arrest (OHCA). We assessed the diagnostic accuracy and clinical benefit of a new AED algorithm (cprINSIGHT), which analyzes ECG and impedance signals during CC, allowing rhythm analysis with ongoing chest compressions. MethodsAmsterdam Police and Fire Fighters used a conventional AED in 2016−2017 (control) and an AED with cprINSIGHT in 2018−2019 (intervention). In the intervention AED, cprINSIGHT was activated after the first (conventional) analysis. This algorithm classified the rhythm as “shockable” (S) and “non-shockable” (NS), or “pause needed”. Sensitivity for S, specificity for NS with 90% lower confidence limit (LCL), chest compression fractions (CCF) and pre-shock pause were compared between control and intervention cases accounting for multiple observations per patient. ResultsData from 465 control and 425 intervention cases were analyzed. cprINSIGHT reached a decision during CC in 70% of analyses. Sensitivity of the intervention AED was 96%, (LCL 93%) and specificity was 98% (LCL 97%), both not significantly different from control. Intervention cases had a shorter median pre-shock pause compared to control cases (8 s vs 22 s, p < 0.001) and higher median CCF (86% vs 80%, P < 0.001). ConclusionAEDs with cprINSIGHT analyzed the ECG during chest compressions in 70% of analyses with 96% sensitivity and 98% specificity when it made a S or a NS decision. Compared to conventional AEDs, cprINSIGHT leads to a significantly shorter pre-shock pause and a significant increase in CCF.
Highlights
In out-of-hospital cardiac arrest (OHCA), Automated External Defibrillators (AED) are increasingly used before Emergency Medical Services (EMS) arrive on the scene
To assess the clinical value of the algorithm, we analyzed the sensitivity and specificity of its heart rhythm decisions, and compared the chest compression fraction (CCF) and pre-shock pauses with a conventional AED algorithm, during the resuscitation of patients in OHCA
Excluding the cases with missing AED ECG or user failure to deliver cardiopulmonary resuscitation (CPR), 465 control cases and 425 intervention cases were included for analysis (Fig. 2)
Summary
In out-of-hospital cardiac arrest (OHCA), Automated External Defibrillators (AED) are increasingly used before Emergency Medical Services (EMS) arrive on the scene. A new algorithm (cprINSIGHT) incorporated in an AED analyzes the heart rhythm during chest compressions, permitting the rescuer to continue cardiopulmonary resuscitation (CPR) during rhythm analysis. Study physicians (CG and RWK) reviewed all AED decisions and associated rhythms.The AED decision was classified as correct or incorrect, based on a visual inspection of the unfiltered AED ECG segments with ongoing chest compressions and during pauses for ventilations before and after each decision For both the LP1000 and LPCR2 cases the sensitivity and specificity were calculated for all analyses after the first analysis. CCFs and pre-shock pauses were analyzed for all 2-min cycles and shocks starting with the first chest compression after the first analysis to the end of the last full cycle before the disconnection of the AED. Statistical analyses were performed using IBM SPSS statistics 25 (IBM Corporation, Armonk, NY)
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