Abstract
AimAn increasing number of failing automated external defibrillators (AEDs) is reported: AEDs not giving a shock or other malfunction. We assessed to what extent AEDs are ‘failing’ and whether this had a device-related or operator-related cause. MethodsWe studied analysis periods from AEDs used between January 2012 and December 2014. For each analysis period we assessed the correctness of the (no)-shock advice (sensitivity/specificity) and reasons for an incorrect (no)-shock advice. If no shock was delivered after a shock advice, we assessed the reason for no-shock delivery. ResultsWe analyzed 1114 AED recordings with 3310 analysis periods (1091 shock advices; 2219 no-shock advices). Sensitivity for coarse ventricular fibrillation was 99% and specificity for non-shockable rhythm detection 98%. The AED gave an incorrect shock advice in 4% (44/1091) of all shock advices, due to device-related (n=15) and operator-related errors (n=28) (one unknown). Of these 44 shock advices, only 2 shocks caused a rhythm change. One percent (26/2219) of all no-shock advices was incorrect due to device-related (n=20) and operator-related errors (n=6). In 5% (59/1091) of all shock advices, no shock was delivered: operator failed to deliver shock (n=33), AED was removed (n=17), operator pushed ‘off' button (n=8) and other (n=1). Of the 1073 analysis periods with a shockable rhythm, 67 (6%) did not receive an AED shock. ConclusionErrors associated with AED use are rare (4%) and when occurring are in 72% caused by the operator or circumstances of use. Fully automatic AEDs may prevent the majority of these errors.
Highlights
To increase early defibrillation, automated external defibrillator (AED) programs have been introduced, including traditional first responder automated external defibrillators (AEDs) programs [1,2], public access defibrillation programs [3–7], and AED programs where the dispatcher plays the key role in guiding lay rescuers to the cardiac arrest patients [8–10]
This study describes experience with AED use in of-hospital cardiac arrest (OHCA) in The Netherlands and shows that in more than 95% of the analysis periods, AEDs are used correctly and deliver shocks when indicated
All studied AEDs comply with the accepted diagnostic rhythm performance standards in real OHCA
Summary
To increase early defibrillation, automated external defibrillator (AED) programs have been introduced, including traditional first responder AED programs [1,2], public access defibrillation programs [3–7], and AED programs where the dispatcher plays the key role in guiding lay rescuers to the cardiac arrest patients [8–10]. In The Netherlands, the percentage of connected AEDs in patients with an out-of-hospital cardiac arrest (OHCA) has almost tripled between 2006 and 2012, from 21% to 59% [11]. Studies about AED performance in cases of OHCA are scarce. One study reviewed AED performance of currently available AEDs operated by emergency medical service (EMS) personnel [12]. Since AEDs are increasingly used by first responders and lay rescuers, who may use an AED only rarely and may have difficulties operating the AED, it is important to evaluate first responder and lay rescuer AED performance. The aims of this study were (1) to determine diagnostic performance of AEDs in rhythm detection in OHCA patients, (2) to study the rescuers’ performance to deliver the advised shocks, and (3) to identify possible causes for inappropriate shock delivery or no-shock delivery after a shock advice
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