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Adherence to automated external defibrillator instructions during real-life in-hospital cardiac arrest: an analysis

Katharina Lanzke1, Oliver Happel1, Thomas Wurmb1

  • 1University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany.

Resuscitation
|January 31, 2026
PubMed

Insights

Healthcare professionals frequently ignored automated external defibrillator (AED) prompts for improving chest compression quality during in-hospital cardiac arrest (IHCA). Adherence to critical AED instructions is vital for survival, yet compliance with corrective prompts remains low.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Resuscitation Science

Background:

  • High-quality chest compressions (CC) and prompt defibrillation are critical for survival during in-hospital cardiac arrest (IHCA).
  • Automated external defibrillators (AEDs) are used in hospitals to reduce defibrillation delays.
  • This study investigated adherence to AED prompts by healthcare professionals during IHCA and its impact on CC quality.

Purpose of the Study:

  • To evaluate adherence rates to various AED prompts during IHCA events.
  • To determine the association between adherence to AED prompts and the quality of chest compressions.
  • To identify potential improvements for AED systems to enhance user compliance and resuscitation outcomes.

Main Methods:

  • A retrospective observational study analyzing real AED data from a German hospital (2007-2024).
  • Included time-stamped documentation of rhythm analysis, voice prompts, and CC quality metrics.
  • Defined adherence as timely prompt implementation; statistical analyses included descriptive statistics, GEE, and chi-square tests.

Main Results:

  • Analyzed 419 out of 466 AED files; prompt adherence varied significantly (15.3%–81.1%).
  • High adherence for "start CPR" (81.1%) and "press shock button" (77.7%), but low for "push harder" (15.3%).
  • Adherence to "push harder" correlated with improved CC depth and was associated with high-quality CC (54.6%).

Conclusions:

  • Healthcare professionals demonstrated high adherence to core AED prompts but lower compliance with corrective instructions.
  • AEDs for professionals could benefit from features like pre-analysis countdowns or alert tones to improve compliance.
  • Enhancing AEDs with motivational-corrective feedback and prompts for rescuer rotation is recommended for sustained high-quality CPR.
Abstract

Keywords:
AEDAutomated external defibrillatorCPRCardiopulmonary resuscitationChest compressionsHealthcare providersHigh qualityIn-hospital cardiac arrestInstructionsProfessionalsVoice prompts

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