Inaccurate treatment decisions of automated external defibrillators used by emergency medical services personnel: Incidence, cause and impact on outcome

Calle, Paul; Mpotos, Nicolas; Calle, Simon; Monsieurs, Koenraad G.

doi:10.1016/j.resuscitation.2014.12.017

Cited by 24 publications

(8 citation statements)

References 23 publications

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“…In one patient an incorrect shock has been given by the AED while there was asystole with many artefacts on the ECG, possibly also due to the unusual conditions. 8,35,36 For the KRNM, it is important to monitor the quality of CPR to improve the quality of future crew training. For this reason, the data on CPR quality was of great interest, but collecting this data was only possible by means of a time-consuming manually method.…”

Section: Discussionmentioning

confidence: 99%

Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews

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Nieuwenburg

Linden³

et al. 2019

Resuscitation

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Background: Little is known regarding circumstances, outcomes and quality of cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) performed by operational lifeboat crews. Our aim is to evaluate circumstances, outcomes and quality of CPR performed by the Royal Dutch Lifeboat Institution (KNRM) in out-of-hospital cardiac arrest (OHCA). Methods:The internal KNRM database has been used to identify and analyse all OHCA cases between July 2011 and December 2017. A limited set of AED data was available to study the quality of CPR.Results: In 37 patients the lifeboat crew members have performed CPR, of which 29 (78.4%) occurred under hostile conditions. The median response time to arrive at the location was 15 min. In 11 (29.7%) patients return of spontaneous circulation was achieved at any moment during CPR and 3 (8.1%) patients were still alive after one month. The lifeboat AED was used in 12 patients. Their recordings show a high median compression frequency (120, IQR 111-131) and prolonged median interruption periods (pre-analysis pause 11s (IQR 10-13), post-analysis pause 4s (IQR 3-8), pre-shock pause 24s (IQR 19-26), post-shock pause 6s (IQR 6-11), ventilation pause 6s (IQR 4-8) and other pauses 9s (IQR 4-17)).Conclusions: Compared to most out-of-hospital resuscitations, resuscitations by lifeboat crews have a low incidence, occur under difficult circumstances and in a younger population. AED's on lifeboats have not contributed to any of the survivals. Analysis of AED information can be used to study the quality of CPR and provide input for improving future training of lifeboat crews.

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Section: Discussionmentioning

confidence: 99%

Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews

Seesink

Nieuwenburg

Linden³

et al. 2019

Resuscitation

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“…In the literature, there are very limited data on the sensitivity/specificity of manual defibrillation: Cheskes et al reported a sensitivity/specificity of 1.0/0.99 in basic and ALS teams15 ; Kramer-Johansen et al reported up to 26% inappropriate shocks16 and Pytte et al, in a simulation study, found a sensitivity/specificity of 1.0/0.89 17. For automated defibrillation, in contrast, studies show sensitivity/specificity: 0.91–1.00/0.96–0.99,11 0.84/0.96,10 and 0.97–1.0/0.97–1.0 12. The overall sensitivity/specificity of the physicians included in our simulation is therefore essentially identical to those found with AEDs and other manual defibrillation studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, in France, as in the majority of European countries, emergency physicians (EPs) can use a manual defibrillator 8. A fairly extensive literature exists on the performance (sensitivity, specificity, speed of recognition) of AEDs, in contrast to the performance of EPs, which has been poorly explored 9–13…”

Section: Introductionmentioning

confidence: 99%

Assessment of emergency physicians’ performance in identifying shockable rhythm in out-of-hospital cardiac arrest: an observational simulation study

et al. 2022

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BackgroundEmergency physicians can use a manual or an automated defibrillator to provide defibrillation of patients who had out-of-hospital cardiac arrest (OHCA). Performance of emergency physicians in identifying shockable rhythm with a manual defibrillator has been poorly explored whereas that of automated defibrillators is well known (sensitivity 0.91–1.00, specificity 0.96–0.99). We conducted this study to estimate the sensitivity/specificity and speed of shock/no-shock decision-making by prehospital emergency physicians for shockable or non-shockable rhythm, and their preference for manual versus automated defibrillation.MethodsWe developed a web application that simulates a manual defibrillator (https://simul-shock.firebaseapp.com/). In 2019, all (262) emergency physicians of six French emergency medical services were invited to participate in a study in which 60 ECG rhythms from real OHCA recordings were successively presented to the physicians for determination of whether they would or would not administer a shock. Time to decision was recorded. Answers were compared with a gold standard (concordant answers of three experts). We report sensitivity for shockable rhythms (decision to shock) and specificity for non-shockable rhythms (decision not to shock). Physicians were also asked whether they preferred manual or automated defibrillation.ResultsAmong 215 respondents, we were able to analyse results for 190 physicians. 57% of emergency physicians preferred manual defibrillation. Median (IQR) sensitivity for a shock delivery for shockable rhythm was 0.91 (0.81–1.00); median specificity for no-shock delivery for non-shockable rhythms was 0.91 (0.80–0.96). More precisely, sensitivities for shock delivery for ventricular tachycardia (VT) and coarse ventricular fibrillation (VF) were both 1.0 (1.0–1.0); sensitivity for fine VF was 0.6 (0.2–1). Specificity for not shocking a pulseless electrical activity (PEA) was 0.83 (0.72–0.86), and for asystole, specificity was 0.93 (0.86–1). Median speed of decision-making (in seconds) were: VT 2.0 (1.6–2.7), coarse VF 2.1 (1.7–2.9), asystole 2.4 (1.8–3.5), PEA 2.8 (2.0–4.2) and fine VF 2.8 (2.1–4.3).ConclusionsGlobal sensitivity and specificity were comparable with published automated external defibrillator studies. Shockable rhythms with the best clinical prognoses (VT and coarse VF) were very rapidly recognised with very good sensitivity. The decision-making for fine VF or asystole and PEA was less accurate.

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“…This case illustrates that the specificity of shock/no-shock decisions by the AEDs is not 100 % [ 1 , 2 ]. Cardiologists should also be aware that AED sensitivity figures are only within a 90–95 % range, and that external artefacts during the analysis process (such as chest compressions) decrease the accuracy significantly.…”

Section: Answermentioning

confidence: 99%

A fatal combination of situs inversus, pregnancy and cardiac arrest treated with an automated external defibrillator

et al. 2016

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Inaccurate treatment decisions of automated external defibrillators used by emergency medical services personnel: Incidence, cause and impact on outcome

Cited by 24 publications

References 23 publications

Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews

Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews

Assessment of emergency physicians’ performance in identifying shockable rhythm in out-of-hospital cardiac arrest: an observational simulation study

A fatal combination of situs inversus, pregnancy and cardiac arrest treated with an automated external defibrillator

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