Abstract
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.
Keywords
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Article info
Publication history
Published online: January 29, 2021
Accepted:
January 13,
2021
Received in revised form:
January 8,
2021
Received:
August 26,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
