分析在 CPR 期间检测心室颤动的压缩算法：自动体外除颤器的性能比较评估。
Analyze Whilst Compressing algorithm for detection of ventricular fibrillation during CPR: A comparative performance evaluation for automated external defibrillators.
机构信息
Schiller Médical SAS, 4 rue L. Pasteur, F-67160 Wissembourg, France.
Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl 105, 1113 Sofia, Bulgaria.
出版信息
Resuscitation. 2021 Mar;160:94-102. doi: 10.1016/j.resuscitation.2021.01.018. Epub 2021 Jan 30.
OBJECTIVE
The aim of this study was to present new combination of algorithms for rhythm analysis during cardiopulmonary resuscitation (CPR) in automated external defibrillators (AED), called Analyze Whilst Compressing (AWC), designed for decreasing pre-shock pause and early stopping of chest compressions (CC) for treating refibrillation.
METHODS
Two stages for AED rhythm analysis were presented, namely, "Standard Analysis Stage" (conventional shock-advisory analysis run over 5 s after CC interruption every two minutes) and "AWC Stage" (two-step sequential analysis process during CPR). AWC steps were run in presence of CC (Step1), and if shockable rhythm was detected then a reconfirmation step was run in absence of CC (Step2, analysis duration 5 s).
RESULTS
In total 16,057 ECG strips from 2916 out-of-hospital cardiac arrest (OHCA) patients treated with AEDs (DEFIGARD TOUCH7, Schiller Médical, France) were subjected patient-wise to AWC training (8559 strips, 1604 patients) and validation (7498 strips, 1312 patients). Considering validation results, "Standard Analysis Stage" presented ventricular fibrillation (VF) sensitivity Se = 98.3% and non-shockable rhythm specificity Sp>99%; "AWC Stage" decision after Step2 reconfirmation achieved Se = 92.1%, Sp>99%.
CONCLUSION
AWC presented similar performances to other AED algorithms during CPR, fulfilling performance goals recommended by standards. AWC provided advances in the challenge for improving CPR quality by: (i) not interrupting chest compressions for prevalent part of non-shockable rhythms (66-83%); (ii) minimizing pre-shock pause for 92.1% of VF patients. AWC required hands-off reconfirmation in 34.4% of cases. Reconfirmation was also common limitation of other reported algorithms (25.7-100%) although following different protocols for triggering chest compression resumption and shock delivery.
目的
本研究旨在提出一种新的心肺复苏（CPR）期间除颤器（AED）心律分析算法组合，称为压缩时分析（AWC），旨在减少电击前暂停和过早停止胸外按压（CC）以治疗再纤颤。
方法
提出了 AED 心律分析的两个阶段，即“标准分析阶段”（在每两分钟中断 CC 后运行 5s 的常规电击建议分析）和“AWC 阶段”（CPR 期间的两步顺序分析过程）。AWC 步骤在 CC 存在的情况下运行（步骤 1），如果检测到可电击节律，则在没有 CC 的情况下运行重新确认步骤（步骤 2，分析持续时间 5s）。
结果
对 2916 例接受 AED 治疗的院外心脏骤停（OHCA）患者的 16057 条 ECG 条带（DEFIGARD TOUCH7，Schiller Médical，法国）进行了患者特异性的 AWC 训练（8559 条带，1604 例）和验证（7498 条带，1312 例）。考虑到验证结果，“标准分析阶段”呈现出心室颤动（VF）的敏感性 Se=98.3%和非电击节律的特异性 Sp>99%；“AWC 阶段”在步骤 2 重新确认后的决策达到 Se=92.1%，Sp>99%。
结论
AWC 在 CPR 期间的表现与其他 AED 算法相似，符合标准推荐的性能目标。AWC 通过以下方式在提高 CPR 质量方面取得了进展：（i）对 66-83%的非电击节律的常见部分不中断 CC；（ii）使 92.1%的 VF 患者的电击前暂停最小化。在 34.4%的情况下需要手动进行重新确认。尽管触发 CC 恢复和电击输送的协议不同，但其他报告的算法也存在重新确认的常见局限性（25.7-100%）。
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