Calle Paul A, De Paepe P, Van Sassenbroeck D, Monsieurs K G
Ghent University Hospital, Department of Emergency Medicine, De Pintelaan 185, B-9000 Ghent, Belgium.
Resuscitation. 2008 Dec;79(3):482-9. doi: 10.1016/j.resuscitation.2008.07.016. Epub 2008 Sep 21.
The ECG analysis algorithm of automated external defibrillators (AEDs) shows reduced sensitivity and specificity in the presence of external artifacts. Therefore, ECG analyses are preceded by voice prompts. We investigated if advanced life support (ALS) providers follow these prompts, and the consequences if they do not.
In a two-tiered EMS system all 510 ECG analyses from 135 resuscitation attempts with a Laerdal FR2 AED (applied by emergency medical technicians [EMTs] and subsequently used by ALS providers) were prospectively evaluated. The ALS data were compared with data before arrival of ALS providers (EMT data) using Mc Nemar test.
In the presence of ALS providers, 286 ECG rhythm analyses were performed. In the 96 analyses with shockable rhythms, artifacts were detected in 35 (36%), leading to a wrongful no shock decision in 19 (20%). Corresponding EMT data were 67 analyses with shockable rhythms, with artifacts in 18 (27%; p<0.001) but a wrongful no shock decision in only 3 (4%; p<0.001). ALS providers also failed to deliver the AED shock in 7 of the 77 analyses with an appropriate shock decision (9%). This was never found in the EMT data. In the 190 analyses of a non-shockable rhythm in the presence of ALS providers, artifacts were detected in 120 (63%) leading to one spurious shock (0.5%). Corresponding EMT data were 157 analyses, with artifacts in 87 (55%; p=0.20) but no spurious shocks.
External artifacts were frequently found, sometimes leading to important errors. Consequently, more training is needed, especially for ALS providers.
自动体外除颤器（AED）的心电图分析算法在存在外部伪迹时显示出敏感性和特异性降低。因此，心电图分析之前会有语音提示。我们调查了高级生命支持（ALS）提供者是否遵循这些提示，以及不遵循提示的后果。
在一个两级急救医疗服务（EMS）系统中，对使用Laerdal FR2 AED进行的135次复苏尝试中的510次心电图分析进行了前瞻性评估（由急救医疗技术人员[EMT]应用，随后由ALS提供者使用）。使用Mc Nemar检验将ALS数据与ALS提供者到达之前的数据（EMT数据）进行比较。
在有ALS提供者在场的情况下，进行了286次心电图节律分析。在96次可电击节律分析中，35次（36%）检测到伪迹，导致19次（20%）错误的不电击决定。相应的EMT数据为67次可电击节律分析，18次（27%；p<0.001）有伪迹，但只有3次（4%；p<0.001）错误的不电击决定。在77次做出适当电击决定的分析中，ALS提供者也有7次（9%）未能进行AED电击。在EMT数据中从未发现这种情况。在有ALS提供者在场的情况下对190次不可电击节律的分析中，120次（63%）检测到伪迹，导致一次误电击（0.5%）。相应的EMT数据为157次分析，87次（55%；p=0.20）有伪迹，但没有误电击。
经常发现外部伪迹，有时会导致重要错误。因此，需要更多培训，尤其是对ALS提供者。
