Analyze Whilst Compressing algorithm for detection of ventricular fibrillation during CPR: A comparative performance...

Area of Science:

• Cardiology
• Biomedical Engineering
• Emergency Medicine

Background:

• Automated external defibrillators (AEDs) are crucial for treating out-of-hospital cardiac arrest (OHCA).
• Current AED algorithms often require significant interruptions in chest compressions (CC) for rhythm analysis, potentially reducing resuscitation effectiveness.
• Optimizing AED rhythm analysis during cardiopulmonary resuscitation (CPR) is essential for improving patient outcomes.

Purpose of the Study:

• To introduce and evaluate a novel algorithm, Analyze Whilst Compressing (AWC), for AED rhythm analysis during CPR.
• To assess AWC's ability to decrease pre-shock pauses and minimize CC interruptions.
• To compare AWC's performance against conventional AED analysis methods.

Main Methods:

• A two-stage AED rhythm analysis approach was developed: a "Standard Analysis Stage" and the proposed "AWC Stage".
• The AWC Stage involves a two-step sequential analysis during CPR, with an initial analysis during CC (Step 1) and a reconfirmation without CC if a shockable rhythm is detected (Step 2).
• The algorithm was trained and validated on 16,057 ECG strips from 2916 OHCA patients.

Main Results:

• The AWC Stage achieved a sensitivity of 92.1% for ventricular fibrillation (VF) and a specificity of over 99% for non-shockable rhythms.
• AWC successfully avoided interrupting chest compressions for 66-83% of non-shockable rhythms.
• The pre-shock pause was minimized for 92.1% of VF patients, with hands-off reconfirmation required in 34.4% of cases.

Conclusions:

• The AWC algorithm demonstrates comparable performance to existing AED algorithms while adhering to established standards.
• AWC offers significant advancements in improving CPR quality by reducing CC interruptions and minimizing pre-shock pauses.
• The AWC algorithm presents a promising approach for enhancing AED effectiveness in OHCA resuscitation.