Análisis inadecuados de los desfibriladores externos semiautomáticos durante la parada cardiorrespiratoria extrahospitalaria

Abstract

ObjectiveTo estimate the frequency of therapeutic errors and to evaluate the diagnostic accuracy in the recognition of shockable rhythms by automated external defibrillators. DesignA retrospective descriptive study. SettingNine basic life support units from Biscay (Spain). ParticipantsIncluded 201 patients with cardiac arrest, since 2006 to 2011. MeasurementsThe study was made of the suitability of treatment (shock or not) after each analysis and medical errors identified. The sensitivity, specificity and predictive values with 95% confidence intervals were then calculated. ResultsA total of 811 electrocardiographic rhythm analyses were obtained, of which 120 (14.1%), from 30 patients, corresponded to shockable rhythms. Sensitivity and specificity for appropriate automated external defibrillators management of a shockable rhythm were 85% (95% CI, 77.5% to 90.3%) and 100% (95% CI, 99.4% to 100%), respectively. Positive and negative predictive values were 100% (95% CI, 96.4% to 100%) and 97.5% (95% CI, 96% to 98.4%), respectively. There were 18 (2.2%; 95% CI, 1.3% to 3.5%) errors associated with defibrillator management, all relating to cases of shockable rhythms that were not shocked. One error was operator dependent, 6 were defibrillator dependent (caused by interaction of pacemakers), and 11 were unclassified. ConclusionsAutomated external defibrillators have a very high specificity and moderately high sensitivity. There are few operator dependent errors. Implanted pacemakers interfere with defibrillator analyses.