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Transfer of essential AED information to treating hospital (TREAT)
Paulien C M Homma1, Corina de Graaf1, Hanno L Tan1
1Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, Amsterdam, The Netherlands.
Insights
Automated External Defibrillator (AED) use in out-of-hospital cardiac arrest (OHCA) is common, but vital AED rhythm data is often not transferred to physicians. This gap in information can impact patient care.
Area of Science:
- Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- Automated External Defibrillators (AEDs) are increasingly used for out-of-hospital cardiac arrest (OHCA).
- AEDs often document shockable rhythms, but this information is frequently unavailable to treating physicians.
- This lack of data transfer poses a challenge in managing OHCA patients.
Purpose of the Study:
- To quantify the frequency of shockable rhythms documented solely by AEDs in OHCA.
- To assess the rate at which this critical AED rhythm information reaches treating physicians.
- To identify gaps in the communication of AED data during OHCA events.
Main Methods:
- Retrospective analysis of the Amsterdam Resuscitation Study (ARREST) database (2012-2014 and 2016).
- Inclusion of OHCA patients with a presumed cardiac cause and AED use.
- Review of EMS run sheets and hospital discharge letters; prospective physician contact in Study Period 2 to assess awareness of AED findings.
Main Results:
- In Study Period 1, 13% of OHCA patients received AED defibrillation only, with 4% of hospital records lacking shockable rhythm information.
- In Study Period 2, 11% of OHCA patients received AED defibrillation only, and in two instances, the physician was unaware of a shockable rhythm.
- These findings indicate a persistent issue with AED data communication.
Conclusions:
- Shockable rhythms are exclusively identified by AEDs in 11-13% of OHCA cases.
- Effective transfer of essential AED data to physicians is crucial but not consistently achieved.
- Improving AED data dissemination is vital for optimal OHCA patient management.
Background:
Defibrillation in out-of-hospital cardiac arrest (OHCA) is increasingly performed by using an Automated External Defibrillator (AED). Therefore presence of a shockable rhythm is recurrently only documented by the AED. However, AED-information is rarely available to the treating physician.
Purpose:
To determine (1) how often a shockable rhythm was recorded only in the AED; (2) if so, how often information that a shockable rhythm had been present reached the physician.
Methods:
Data on OHCA patients with (presumed) cardiac cause with an AED connected in the years 2012-2014 (Study period 1) and 2016 (Study period 2) in the Amsterdam Resuscitation Study (ARREST) database were collected. We determined how often only the AED had defibrillated. In these patients, we retrospectively analyzed EMS run sheets and hospital discharge letters to determine if a shockable rhythm and/or AED use was correctly noted. In Study period 2, we prospectively contacted the physicians to study whether AED defibrillation was known.
Results:
In Study period 1, of 2840 OHCA CPR attempts with (presumed) cardiac cause, 1521 (54%) patients had a shockable rhythm, with 356 patients (13%) receiving AED defibrillation only. Of these patients, 11 hospital discharge letters (4%) contained no information about a shockable rhythm. In Study period 2, 125/1128 patients (11%) received AED defibrillation only; of these, in two cases the shockable rhythm was unknown by the physician.
Conclusion:
In 11-13% of OHCAs, a shockable rhythm is only seen on the AED-ECG. Adequate transfer to the physician of vital AED-information is essential but not always accomplished.
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