院外环境中自动体外除颤器使用的性能与误差分析。

Performance and error analysis of automated external defibrillator use in the out-of-hospital setting.

作者信息

Macdonald R D, Swanson J M, Mottley J L, Weinstein C

机构信息

Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA.

出版信息

Ann Emerg Med. 2001 Sep;38(3):262-7. doi: 10.1067/mem.2001.117953.

DOI:10.1067/mem.2001.117953

PMID:11524645

Abstract

STUDY OBJECTIVE

We determined whether automated external defibrillators (AEDs) can meet the American Heart Association performance criteria to detect and shock unstable cardiac rhythms (ventricular fibrillation [VF], ventricular tachycardia [VT]) in the setting of an out-of-hospital cardiac arrest.

METHODS

AED performance was reviewed for cardiac arrests occurring between January 1, 1995, and December 31, 1997. After every cardiac arrest, data regarding each rhythm analyzed and subsequent response (shock or no shock) were downloaded from the AED memory module. The study paramedic and study physician independently reviewed each case and interpreted cardiac rhythms from downloaded AED data. The emergency medical services medical director resolved all discrepancies in a blinded manner. All cases of out-of-hospital cardiac arrest in which an AED was turned on and a rhythm analyzed were included. The primary objective was the correct identification and defibrillation of VF or VT. Sensitivity, specificity, and predictive values with 95% confidence intervals (CIs) were calculated. Sources of error in AED rhythm management are also described.

RESULTS

A total of 3,448 AED rhythms were available for interpretation. Sensitivity and specificity for appropriate AED management of a shockable (VF or VT) rhythm were 81.0% (95% CI 77.9% to 83.8%) and 99.9% (95% CI 99.7% to 100%), respectively. Positive and negative predictive values were 99.6% (95% CI 98.7% to 99.9%) and 95.5% (95% CI 94.7% to 96.2%), respectively. There were 132 errors associated with AED management. Two errors resulted in delivery of an inappropriate shock. In the remaining 130 errors, a shockable rhythm was not shocked. Fifty-five (42.3%) errors were AED dependent, 70 (53.9%) were operator dependent, and 5 (3.9%) were unclassified.

CONCLUSION

The AED had high specificity and moderately high sensitivity in detecting and shocking unstable cardiac rhythms in the out-of-hospital setting. Few cardiac rhythms were mismanaged by the AED. Elimination of operator-dependent errors could increase AED sensitivity.

摘要

研究目的

我们确定自动体外除颤器（AED）是否能够满足美国心脏协会的性能标准，以检测并电击院外心脏骤停时的不稳定心律（心室颤动[VF]、室性心动过速[VT]）。

方法

回顾了1995年1月1日至1997年12月31日期间发生心脏骤停时AED的性能。每次心脏骤停后，从AED存储模块下载有关分析的每种心律及后续反应（电击或未电击）的数据。参与研究的护理人员和研究医生独立审查每个病例，并根据下载的AED数据解读心律。紧急医疗服务医疗主任以盲法解决所有差异。纳入所有开启AED并分析了心律的院外心脏骤停病例。主要目标是正确识别和除颤VF或VT。计算了敏感性、特异性和预测值以及95%置信区间（CI）。还描述了AED心律管理中的误差来源。

结果

共有3448次AED心律可供解读。对可电击（VF或VT）心律进行适当AED管理的敏感性和特异性分别为81.0%（95%CI 77.9%至83.8%）和99.9%（95%CI 99.7%至100%）。阳性和阴性预测值分别为99.6%（95%CI 98.7%至99.9%）和95.5%（95%CI 94.7%至96.2%）。与AED管理相关的误差有132次。两次误差导致不适当的电击。在其余130次误差中，可电击心律未被电击。55次（42.3%）误差与AED有关，70次（53.9%）与操作人员有关，5次（3.9%）未分类。