Clinical performance of AED shock advisory system with integrated Analyze Whilst Compressing algorithm for analysis of the ECG rhythm during out-of-hospital cardiopulmonary resuscitation: A secondary analysis of the DEFI 2022 study

• Published in: Resuscitation plus 2024-09, Vol.19, p.100740, Article 100740
• Main Authors: Didon, Jean-Philippe, Jekova, Irena, Frattini, Benoît, Ménétré, Sarah, Derkenne, Clément, Ha, Vivien Hong Tuan, Jost, Daniel, Krasteva, Vessela
• Format: Article
• Language: English
• Subjects: Algorithm; Automated external defibrillator (AED); Cardiac arrest; Cardiopulmonary resuscitation (CPR); Chest compression; CPR artifact; ECG analysis; Ventricular fibrillation
• ISSN: 2666-5204; 2666-5204
• DOI: 10.1016/j.resplu.2024.100740

This study involving automated external defibrillators (AEDs) in early treatment of refibrillation aims to evaluate the performance of a new shock advisory system (SAS) during chest compressions (CC) in out-of-hospital cardiac arrest (OHCA) patients. This work focuses on AED SAS performance as a secondary outcome of DEFI 2022 clinical prospective study, which included first-analysis shockable OHCA patients. SAS employs the Analyze Whilst Compressing (AWC) algorithm to interact with both cardiopulmonary resuscitation (CPR) and shock advice by conditional operation of two-stage ECG analysis in presence or absence of chest compressions. AWC is triggered by the first-shock recommendation. Then, after 1 min of CPR, ECG analysis during CC decides between two treatment scenarios. For patients with refibrillation, CPR is paused for immediate confirmation analysis and shock advice. For patients with non-shockable rhythms, CPR is continued for 2 min until standard analysis. Clinical data from 285 OHCA patients with shock recommendation at the first-analysis by AEDs (DEFIGARD TOUCH7, Schiller Médical) consisted of 576 standard analyses, 2011 analyses during CC, 577 confirmation analyses in absence of CC. Global AED SAS performance meets the standard recommendations for arrhythmia analysis sensitivity (94.9%) and specificity (>99.3%). AWC provided innovative treatment of shockable rhythms by stopping CPR earlier than 2 min in most ventricular fibrillations (92.9%), while most non-shockable patients (86.5–95.2%) benefitted from continuous CPR for at least 2 min. This study provides positive evidence for routine use of AEDs with AWC-integrated algorithm for ECG analysis during CPR by first-responders in early OHCA treatment. Clinical Trial Registration: Registration number: NCT04691089, trial register: ClinicalTrials.gov.