Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China; The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China.
Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Resuscitation. 2019 Oct;143:1-9. doi: 10.1016/j.resuscitation.2019.07.026. Epub 2019 Aug 1.
To explore a new algorithm and strategy for rhythm analysis during chest compressions (CCs), and to improve the efficiency of cardiopulmonary resuscitation (CPR) by minimizing interruptions.
The clinical data and ECG of patients with sudden cardiac arrest (CA) from three hospitals in China were collected with Philips MRx monitor/defibrillators. The length of each analyzed ECG segment was 23 s, the first 11.5 s was selected to contain CPR compressions, the next 5 s had no compressions, and the last 6.5 s had no requirement. Three experienced emergency doctors annotated the ECG segments without compression artifacts. A two-step analysis through CPR (ATC) algorithm was applied to the selected data. The first step was analysis during chest compressions. If a shockable rhythm was not detected, compression-free analysis followed. The results of the ATC algorithm were compared with the annotations by the physicians, to determine the sensitivity and specificity of the algorithm.
In total 166 CA patients were included with 100 out-of-hospital cardiac arrest (OHCA) patients and 66 in-hospital cardiac arrest (IHCA) patients. A total of 1578 ECG segments were analyzed, including 115 (7.3%) shockable rhythms, 1278 (81.0%) non-shockable rhythms, and 185 (11.7%) intermediate/unknown rhythms. The specificity of all non-shockable rhythms was 99.8% at the end of chest compressions, and 99.5% after analysis without compression artifact. 70.5% of ventricular fibrillation (VF) rhythms were detected by the end of chest compressions. After the CC-free analysis, 93.6% of VF was identified.
The ATC algorithm achieved sensitivity of 93.6% and specificity of 99.5% after the two-step analysis, and 70.5% of the patients with shockable rhythms did not require CC-free analysis. Such an approach has the potential to substantially reduce CC interruptions when identifying shockable rhythms.
探索一种新的胸外按压（CCs）时的节律分析算法和策略，通过最小化中断来提高心肺复苏（CPR）的效率。
使用飞利浦 MRx 监测除颤仪从中国 3 家医院的突发心搏骤停（CA）患者中收集临床数据和心电图。每个分析的 ECG 片段长度为 23s，前 11.5s 选择包含 CPR 按压，接下来 5s 没有按压，最后 6.5s 没有要求。3 名有经验的急诊医生对没有按压伪影的 ECG 片段进行注释。应用两步式通过 CPR（ATC）算法对选定的数据进行分析。第一步是在 CCs 期间进行分析。如果未检测到可电击节律，则进行无 CC 分析。将 ATC 算法的结果与医生的注释进行比较，以确定算法的灵敏度和特异性。
共纳入 166 例 CA 患者，其中 100 例为院外心脏骤停（OHCA）患者，66 例为院内心脏骤停（IHCA）患者。共分析了 1578 个 ECG 片段，包括 115 个（7.3%）可电击节律、1278 个（81.0%）不可电击节律和 185 个（11.7%）中间/未知节律。在 CC 结束时，所有不可电击节律的特异性均为 99.8%，在无 CC 伪影分析后特异性为 99.5%。70.5%的室颤（VF）节律在 CC 结束时被检测到。在无 CC 分析后，93.6%的 VF 被识别。
在两步分析后，ATC 算法的灵敏度为 93.6%，特异性为 99.5%，70.5%的可电击节律患者不需要进行无 CC 分析。这种方法在识别可电击节律时有可能大大减少 CC 中断。
