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Incidents occurring while using semi-automatic external defibrillators during an out-of-hospital cardiac arrest: An observational study
22
Abstracts / Resuscitation 96S (2015) 5–42
pre-shock pause. The decrease in AMSA is larger for VF with worse prognosis. http://dx.doi.org/10.1016/j.resuscitation.2015.09.049
References 1. Ristagno, et al. Resuscitation 2013;84:1697–703. 2. Indik, et al. JACC 2014;64:1362–9.
AS038
http://dx.doi.org/10.1016/j.resuscitation.2015.09.050
Differences in AMSA based shock outcome prediction between shock success and hospital admission and discharge
AS039
Beatriz Chicote 1,∗ , Unai Irusta 1 , Elisabete Aramendi 1 , Javier Gil 2 , Andima Larrea 2 , Carlos Jover 2 , Jose Veintemillas 2 1 University of the Basque Country (UPV/EHU), Bilbao, Spain 2 Emergencies Medical System, Basque Country, Basque Country, Spain
Purpose: Amplitude spectrum area (AMSA) is a widespread shock success predictor. Generally, successful shocks refer to restoration of an organized rhythm, however this definition may not be later clinically substantiated. The objective of this study was to analyze differences in AMSA shock outcome prediction for different outcome measures: shock success vs hospital admission and discharge. Materials and methods: Data from 78 out-of-hospital cardiac arrest patients (64 male and 14 female, median age 69 (range, 32–90)) were analysed, 29 patients were admitted to hospital and 9 were discharged alive. There were 230 shocks, 2 (IQR 1–5) per patient. ECG digital tracings were obtained from LifePack 1000 (68), FR2 (6) and Zoll AED Pro (4) AEDs and resampled to a sampling rate of 250 Hz. Shock success was defined as QRS complexes (rate > 30 bpm) appearing within 60 s after the shock, 53 shocks were successful and 177 unsuccessful. AMSA was computed 1s before the shock, using a 2.05 s tuckey window and a 4–48 Hz frequency-range.1 For the admitted and discharged alive end points, AMSA was averaged over all shocks for each patient (AMSA-avg).2 Results: Median AMSA values for good/bad outcomes for the different end points were 13.1/7.7 mV Hz for shock success, and 12.4/7.6 mV Hz and 12.2/9.2 mV Hz for hospital admission and discharged alive, respectively (p < 0.05 in all cases). The sensitivity/specificity analysis showed an Area Under the Curve (AUC) of 0.77, 0.76 and 0.73 for the different end points.
Incidents occurring while using semi-automatic external defibrillators during an out-of-hospital cardiac arrest: An observational study Mathieu Wolf 1 , Pascal Diegelmann 1 , Mickael Lemaire 1 , Flora Jourquin 1 , Sylvie Margerin 1 , Daniel Jost 1,∗ , Florence Dumas 2 , Michel Bignand 1 , Jean-Pierre Tourtier 1 1 2
Fire Brigade of Paris, Paris, France Sudden Death Expertise Center, Paris, France
Purpose: During an out-of-hospital cardiac arrest (OHCA), the use of semi-automatic external defibrillators (AED) by professional rescuers has greatly improved the prognosis of victims. However, in some cases AEDs have failed. This study aimed to identify and classify these incidents. Materials and methods: This was a retrospective observational study. The description involved OHCA victims having received an AED procedure before arrival of the medical team. The incident census was prepared using the mandatory procedure reports issued by care personnel; this report included the following item: “Occurred AED incident.” Results: From October 2010 to October 2014, over 15,710 AED applications, professional rescuers reported 62 (0.004%) incidents during the procedure. These incidents were: accidental electrode detachment (n = 36), AED malfunction due to a technical problem (motherboard, battery: n = 15), no external electric shock (EES) on ventricular fibrillation (n = 6), electric arc during shock administration (n = 5). None of the professional rescuers was electrified while using AEDs. After completing the procedure, 708 (4.5%) issues were reported, related to sending AED recorded data to the dedicated server, with data loss in less than 10 cases. Conclusions: A previous cohort (1999) on the same population reported 86 incidents in 1048 SAED uses (8.2%). Less serious incidents were the most frequent (remote data transmission, peeling electrode), likely with some under-reporting. We propose a classification of incidents into 3 categories: 1. Incidents involving EES administration failure; 2. Incidents involving a risk in terms of safety for users (electrification) or for the patient (abusive shock); 3. Loss of data recorded by the AED. The use of consensual classification of incidents and their comprehensive national census should provide better information to competent authorities to the widespread use of AED. http://dx.doi.org/10.1016/j.resuscitation.2015.09.051
Conclusions: For this patient population AMSA is a good shock outcome predictor for all the analysed end points. AMSA shows very similar values and prediction performance for shock success and hospital admission, and a small decrease in predictive power for patients discharged alive.
Abstracts / Resuscitation 96S (2015) 5–42
pre-shock pause. The decrease in AMSA is larger for VF with worse prognosis. http://dx.doi.org/10.1016/j.resuscitation.2015.09.049
References 1. Ristagno, et al. Resuscitation 2013;84:1697–703. 2. Indik, et al. JACC 2014;64:1362–9.
AS038
http://dx.doi.org/10.1016/j.resuscitation.2015.09.050
Differences in AMSA based shock outcome prediction between shock success and hospital admission and discharge
AS039
Beatriz Chicote 1,∗ , Unai Irusta 1 , Elisabete Aramendi 1 , Javier Gil 2 , Andima Larrea 2 , Carlos Jover 2 , Jose Veintemillas 2 1 University of the Basque Country (UPV/EHU), Bilbao, Spain 2 Emergencies Medical System, Basque Country, Basque Country, Spain
Purpose: Amplitude spectrum area (AMSA) is a widespread shock success predictor. Generally, successful shocks refer to restoration of an organized rhythm, however this definition may not be later clinically substantiated. The objective of this study was to analyze differences in AMSA shock outcome prediction for different outcome measures: shock success vs hospital admission and discharge. Materials and methods: Data from 78 out-of-hospital cardiac arrest patients (64 male and 14 female, median age 69 (range, 32–90)) were analysed, 29 patients were admitted to hospital and 9 were discharged alive. There were 230 shocks, 2 (IQR 1–5) per patient. ECG digital tracings were obtained from LifePack 1000 (68), FR2 (6) and Zoll AED Pro (4) AEDs and resampled to a sampling rate of 250 Hz. Shock success was defined as QRS complexes (rate > 30 bpm) appearing within 60 s after the shock, 53 shocks were successful and 177 unsuccessful. AMSA was computed 1s before the shock, using a 2.05 s tuckey window and a 4–48 Hz frequency-range.1 For the admitted and discharged alive end points, AMSA was averaged over all shocks for each patient (AMSA-avg).2 Results: Median AMSA values for good/bad outcomes for the different end points were 13.1/7.7 mV Hz for shock success, and 12.4/7.6 mV Hz and 12.2/9.2 mV Hz for hospital admission and discharged alive, respectively (p < 0.05 in all cases). The sensitivity/specificity analysis showed an Area Under the Curve (AUC) of 0.77, 0.76 and 0.73 for the different end points.
Incidents occurring while using semi-automatic external defibrillators during an out-of-hospital cardiac arrest: An observational study Mathieu Wolf 1 , Pascal Diegelmann 1 , Mickael Lemaire 1 , Flora Jourquin 1 , Sylvie Margerin 1 , Daniel Jost 1,∗ , Florence Dumas 2 , Michel Bignand 1 , Jean-Pierre Tourtier 1 1 2
Fire Brigade of Paris, Paris, France Sudden Death Expertise Center, Paris, France
Purpose: During an out-of-hospital cardiac arrest (OHCA), the use of semi-automatic external defibrillators (AED) by professional rescuers has greatly improved the prognosis of victims. However, in some cases AEDs have failed. This study aimed to identify and classify these incidents. Materials and methods: This was a retrospective observational study. The description involved OHCA victims having received an AED procedure before arrival of the medical team. The incident census was prepared using the mandatory procedure reports issued by care personnel; this report included the following item: “Occurred AED incident.” Results: From October 2010 to October 2014, over 15,710 AED applications, professional rescuers reported 62 (0.004%) incidents during the procedure. These incidents were: accidental electrode detachment (n = 36), AED malfunction due to a technical problem (motherboard, battery: n = 15), no external electric shock (EES) on ventricular fibrillation (n = 6), electric arc during shock administration (n = 5). None of the professional rescuers was electrified while using AEDs. After completing the procedure, 708 (4.5%) issues were reported, related to sending AED recorded data to the dedicated server, with data loss in less than 10 cases. Conclusions: A previous cohort (1999) on the same population reported 86 incidents in 1048 SAED uses (8.2%). Less serious incidents were the most frequent (remote data transmission, peeling electrode), likely with some under-reporting. We propose a classification of incidents into 3 categories: 1. Incidents involving EES administration failure; 2. Incidents involving a risk in terms of safety for users (electrification) or for the patient (abusive shock); 3. Loss of data recorded by the AED. The use of consensual classification of incidents and their comprehensive national census should provide better information to competent authorities to the widespread use of AED. http://dx.doi.org/10.1016/j.resuscitation.2015.09.051
Conclusions: For this patient population AMSA is a good shock outcome predictor for all the analysed end points. AMSA shows very similar values and prediction performance for shock success and hospital admission, and a small decrease in predictive power for patients discharged alive.