Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Resuscitation. 2021 May;162:320-328. doi: 10.1016/j.resuscitation.2021.01.003. Epub 2021 Jan 16.
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.
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.
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).
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.
在院外心脏骤停（OHCA）期间，自动体外除颤器（AED）提示救援人员停止胸外按压（CC）以进行心电图分析。我们评估了一种新的 AED 算法（cprINSIGHT）的诊断准确性和临床获益，该算法在进行 CC 时分析心电图和阻抗信号，允许在持续进行胸外按压的情况下进行节律分析。
阿姆斯特丹警察和消防员在 2016-2017 年使用常规 AED（对照组），并在 2018-2019 年使用具有 cprINSIGHT 的 AED（干预组）。在干预组的 AED 中，在进行第一次（常规）分析后激活 cprINSIGHT。该算法将节律分类为“可电击”（S）和“不可电击”（NS），或“需要暂停”。在考虑到每个患者的多次观察后，比较了对照组和干预组病例的 S 灵敏度、NS 特异性（90%置信下限[LCL]）、胸外按压分数（CCF）和电击前暂停。
对 465 例对照组和 425 例干预组病例的数据进行了分析。cprINSIGHT 在 70%的分析中在 CC 期间做出决策。干预组 AED 的敏感性为 96%（LCL 为 93%），特异性为 98%（LCL 为 97%），均与对照组无显著差异。与对照组相比，干预组的电击前暂停中位数更短（8s 比 22s，p<0.001），CCF 中位数更高（86%比 80%，p<0.001）。
当 cprINSIGHT 做出 S 或 NS 决策时，具有 cprINSIGHT 的 AED 在 70%的分析中分析了 CC 期间的心电图，其敏感性为 96%，特异性为 98%。与常规 AED 相比，cprINSIGHT 可显著缩短电击前暂停时间，并显著增加 CCF。
