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External artifacts by advanced life support providers misleading automated external defibrillators
Paul A Calle1, P De Paepe, D Van Sassenbroeck
1Ghent University Hospital, Department of Emergency Medicine, De Pintelaan 185, B-9000 Ghent, Belgium. paul.calle@ugent.be
Resuscitation
|September 24, 2008
Summary
Advanced life support (ALS) providers frequently miss automated external defibrillator (AED) prompts, leading to critical errors in artifact detection and shock decisions. Enhanced training is crucial for ALS providers to improve patient care during resuscitation.
Area of Science:
- Emergency medicine
- Cardiology
- Medical device technology
Background:
- Automated external defibrillators (AEDs) use ECG analysis, which is susceptible to external artifacts, reducing accuracy.
- Voice prompts guide users, but adherence by advanced life support (ALS) providers is not well-understood.
Purpose of the Study:
- To evaluate ALS provider adherence to AED voice prompts.
- To determine the impact of non-adherence on ECG analysis and resuscitation outcomes.
Main Methods:
- Prospective evaluation of 510 ECG analyses from 135 resuscitation attempts using a Laerdal FR2 AED in a two-tiered EMS system.
- Comparison of ALS provider data with emergency medical technician (EMT) data prior to ALS arrival.
Main Results:
- ALS providers had higher artifact detection rates (36% vs. 27%) and wrongful no-shock decisions (20% vs. 4%) for shockable rhythms compared to EMTs.
- ALS providers failed to deliver appropriate shocks in 9% of cases, a finding not observed in EMT data.
- Artifacts were common in non-shockable rhythms (63% for ALS vs. 55% for EMTs), with one spurious shock in the ALS group.
Conclusions:
- External artifacts frequently impact AED performance, leading to significant errors, particularly when ALS providers do not follow prompts.
- Increased training for ALS providers is necessary to mitigate these errors and improve AED utilization.
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