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      Return of spontaneous circulation and long‐term survival according to feedback provided by automated external defibrillators

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          Abstract

          Background

          We aimed to investigate the effect of automated external defibrillator (AED) feedback mechanisms on survival in out‐of‐hospital cardiac arrest (OHCA) victims. In addition, we investigated converting rates in patients with shockable rhythms according to AED shock waveforms and energy levels.

          Methods

          We collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs.

          Results

          A total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68%). We found no difference in return of spontaneous circulation (ROSC) at hospital arrival according to AV‐feedback; 34 (55%, 95% confidence interval (CI) [13–67]) vs. 72 (54%, 95% CI [45–62]), P = 1 (odds ratio (OR) 1.1, 95% CI [0.6–1.9]) or 30‐day survival; 24 (39%, 95% CI [28–51]) vs. 53 (40%, 95% CI [32–49]), P = 0.88 (OR 1.1 (95% CI [0.6–2.0])). Moreover, we found no difference in converting rates among patients with initial shockable rhythm receiving one or more shocks according to AED energy waveform and energy level.

          Conclusions

          No difference in survival after OHCA according to AED feedback mechanisms, nor any difference in converting rates according to AED waveform or energy levels was detected.

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          Most cited references32

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          Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.

          Lars Wik, Jo Kramer-Johansen, Helge Myklebust … (2005)
          Cardiopulmonary resuscitation (CPR) guidelines recommend target values for compressions, ventilations, and CPR-free intervals allowed for rhythm analysis and defibrillation. There is little information on adherence to these guidelines during advanced cardiac life support in the field. To measure the quality of out-of-hospital CPR performed by ambulance personnel, as measured by adherence to CPR guidelines. Case series of 176 adult patients with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden, London, England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators recorded chest compressions via a sternal pad fitted with an accelerometer and ventilations by changes in thoracic impedance between the defibrillator pads, in addition to standard event and electrocardiographic recordings. Adherence to international guidelines for CPR. Chest compressions were not given 48% (95% CI, 45%-51%) of the time without spontaneous circulation; this percentage was 38% (95% CI, 36%-41%) when subtracting the time necessary for electrocardiographic analysis and defibrillation. Combining these data with a mean compression rate of 121/min (95% CI, 118-124/min) when compressions were given resulted in a mean compression rate of 64/min (95% CI, 61-67/min). Mean compression depth was 34 mm (95% CI, 33-35 mm), 28% (95% CI, 24%-32%) of the compressions had a depth of 38 mm to 51 mm (guidelines recommendation), and the compression part of the duty cycle was 42% (95% CI, 41%-42%). A mean of 11 (95% CI, 11-12) ventilations were given per minute. Sixty-one patients (35%) had return of spontaneous circulation, and 5 of 6 patients discharged alive from the hospital had normal neurological outcomes. In this study of CPR during out-of-hospital cardiac arrest, chest compressions were not delivered half of the time, and most compressions were too shallow. Electrocardiographic analysis and defibrillation accounted for only small parts of intervals without chest compressions.
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            Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest.

            Benjamin Abella, Jason Alvarado, Helge Myklebust … (2005)
            The survival benefit of well-performed cardiopulmonary resuscitation (CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions (no-flow fraction) were recorded. Adherence to American Heart Association and international CPR guidelines. Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1% of segments. Compression depth was too shallow (defined as <38 mm) for 37.4% of compressions. Ventilation rates were high, with 60.9% of segments containing a rate of more than 20/min. Additionally, the mean (SD) no-flow fraction was 0.24 (0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients (40.3%) achieved return of spontaneous circulation and 7 (10.4%) were discharged from the hospital. In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.
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              Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.

              B. L. Clark, Erin Roe, G Nichol … (2000)
              The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest. We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital. Automated external defibrillators were used, 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients 153 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attachment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to The arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes. Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates.
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                Author and article information

                Contributors
                M. Agerskov:
                ORCID: http://orcid.org/0000-0002-8408-7929
                marianneagerskov@hotmail.com
                Journal
                Journal ID (nlm-ta): Acta Anaesthesiol Scand
                Journal ID (iso-abbrev): Acta Anaesthesiol Scand
                Journal ID (doi): 10.1111/(ISSN)1399-6576
                Journal ID (publisher-id): AAS
                Title: Acta Anaesthesiologica Scandinavica
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0001-5172
                ISSN (Electronic): 1399-6576
                Publication date (Electronic): 13 September 2017
                Publication date (Print): November 2017
                Volume: 61
                Issue: 10 ( doiID: 10.1111/aas.2017.61.issue-10 )
                Pages: 1345-1353
                Affiliations
                [ 1 ] Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet University of Copenhagen Copenhagen Denmark
                [ 2 ] Emergency Medical Services, Copenhagen University of Copenhagen Copenhagen Denmark
                [ 3 ] Department of Cardiology Gentofte Hospital University of Copenhagen Copenhagen Denmark
                Author notes
                [*] [* ] Correspondence

                M. Agerskov, Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark

                E‐mail: marianneagerskov@ 123456hotmail.com

                [†]

                These authors have contributed equally to this work.

                Author information
                http://orcid.org/0000-0002-8408-7929
                Article
                Publisher ID: AAS12992
                DOI: 10.1111/aas.12992
                PMC ID: 5698742
                PubMed ID: 28901546
                SO-VID: 2d39039e-c440-4a83-a9c4-f01f289af0c6
                Copyright © © 2017 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation
                License:

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 07 June 2017
                Date revision received : 16 August 2017
                Date accepted : 18 August 2017
                Page count
                Figures: 1, Tables: 4, Pages: 9, Words: 5040
                Funding
                Funded by: TrygFonden
                Categories
                Subject: Original Article
                Subject: Emergency Medicine
                Custom metadata
                source-schema-version-number 2.0
                component-id aas12992
                cover-date November 2017
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.6 mode:remove_FC converted:22.11.2017

                ScienceOpen disciplines: Anesthesiology & Pain management
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management

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