Analyzing the heart rhythm during chest compressions: Performance and clinical value of a new AED algorithm. (May 2021)

• Record Type: Journal Article
• Authors: de Graaf, Corina; Beesems, Stefanie G.; Oud, Sharon; Stickney, Ronald E.; Piraino, Daniel W.; Chapman, Fred W.; Koster, Rudolph W.
• Is Part Of: Resuscitation. Volume 162(2021)
• Page Start: 320
• Page End: 328
• Publication Date: 2021-05
• Subjects: Out-of-hospital cardiac arrest -- Automated external defibrillator -- Algorithm -- Rhythm analysis -- Chest compressions -- Chest compression fraction -- Pre-shock pause; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.01.003
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Purpose: Automated 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. Methods: Amsterdam 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. Results: Data 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). Conclusion: AEDs 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.