Ghent University, De Pintelaan 185, 9000 Ghent, Belgium; Department of Emergency Medicine, Maria Middelares General Hospital, Kortrijksesteenweg 1026, 9000 Ghent, Belgium.
Ghent University, De Pintelaan 185, 9000 Ghent, Belgium; Department of Emergency Medicine, Ghent Sint Lucas General Hospital, Groene Briel 1, 9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Resuscitation. 2015 Mar;88:68-74. doi: 10.1016/j.resuscitation.2014.12.017. Epub 2014 Dec 31.
The rhythm analysis algorithm (RAA) of automated external defibrillators (AEDs) may be deceived by many factors. In this observational study we assessed RAA accuracy in prehospital interventions. For every rhythm analysis judged to be inaccurate, we looked for causal factors and estimated the impact on outcome.
In 135 consecutive patients, two physicians reviewed 837 rhythm analyses independently. When they disagreed, a third physician made the final decision.
Among 148 shockable episodes, 23 (16%) were not recognized by the RAA due to external artifacts (n=7), fine ventricular fibrillation (VF; n=7), RAA error without external artifacts (n=4) or a combination of factors (n=5). In six cases the omitted/delayed shock was judged to be of clinical relevance: survival with some neurological deficit (n=4), death without regaining consciousness (n=1) and no restoration of spontaneous circulation (n=1). In 689 non-shockable episodes, the RAA decided "shockable" 25 times (4%). This wrongful decision was due to external artifacts (n=9), a concurrent shock of an internal cardioverter defibrillator (n=1), RAA error without external artifacts (n=13) or a combination of factors (n=2). Fifteen spurious shocks were delivered. As these non-shockable rhythms did not deteriorate after the shock, we assumed that no significant harm was done.
Up to 16% of shockable rhythms were not detected and 4% of non-shockable rhythms were interpreted as shockable. Therefore, all AED interventions should be reviewed. Feedback to caregivers may avoid future deleterious interactions with the AED, whereas AED manufacturers may use this information to improve RAA accuracy. This approach may improve the outcome of some VF patients.
自动体外除颤器（AED）的节律分析算法（RAA）可能会受到许多因素的影响。在这项观察性研究中，我们评估了 RAA 在院前干预中的准确性。对于每一次判断不准确的节律分析，我们都寻找因果因素，并估计其对结果的影响。
在 135 例连续患者中，两名医生独立对 837 次节律分析进行了评估。当他们意见不一致时，第三名医生做出最终决定。
在 148 次可电击性发作中，由于外部伪影（n=7）、细颤（VF；n=7）、无外部伪影的 RAA 错误（n=4）或多种因素的组合（n=5），23 次（16%）未被 RAA 识别。在 6 例遗漏/延迟电击的情况下，判断其具有临床相关性：存活但存在一定神经功能缺损（n=4）、无意识恢复的死亡（n=1）和无自主循环恢复（n=1）。在 689 次不可电击性发作中，RAA 25 次（4%）判断为“可电击性”。这一错误决策归因于外部伪影（n=9）、同时发生的内部除颤器电击（n=1）、无外部伪影的 RAA 错误（n=13）或多种因素的组合（n=2）。有 15 次误发电击。由于这些不可电击性节律在电击后没有恶化，我们假设没有造成明显的伤害。
多达 16%的可电击性节律未被检测到，4%的不可电击性节律被判断为可电击性。因此，所有的 AED 干预措施都应进行审查。向护理人员提供反馈信息可能会避免未来与 AED 发生有害的相互作用，而 AED 制造商可能会利用这些信息来提高 RAA 的准确性。这种方法可能会改善一些 VF 患者的结局。
