Comparative performance assessment of commercially available automatic external defibrillators: A simulation and real-life measurement study of hands-off time

• Published in: Resuscitation 2017-01, Vol.110, p.12-17
• Main Authors: Savastano, Simone, Vanni, Vincenzo, Burkart, Roman, Raimondi, Maurizio, Canevari, Fabrizio, Molinari, Simone, Baldi, Enrico, Danza, Aurora I, Caputo, Maria Luce, Mauri, Romano, Regoli, Francois, Conte, Giulio, Benvenuti, Claudio, Auricchio, Angelo
• Format: Article
• Language: English
• Subjects: AED; Cardiopulmonary Resuscitation - instrumentation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - standards; Computer Simulation; CPR; Defibrillators - classification; Defibrillators - standards; Electric Countershock - instrumentation; Electric Countershock - methods; Emergency; Emergency Medical Services - methods; Emergency Medical Services - standards; First Aid - instrumentation; First Aid - methods; First Aid - standards; Hands-off time; Humans; Italy; Manikins; Materials Testing; Out-of-Hospital Cardiac Arrest - therapy; Resuscitation; Task Performance and Analysis; Time Factors; Time-to-Treatment
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2016.10.006

Abstract Purpose Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) are key factors to improve the outcome in patients with cardiac arrest. However, AED peri- and post-shock ECG analysis pauses may prolong hands-off time and reduce CPR effectiveness. Methods This study consisted of 2 independent parts. In the first part, the time performance of 12 different commercially available AEDs was tested in a manikin based scenario; in the second one, the AEDs recordings following the clinical use (same manufacturers as in the benchmark testing) in 2 different regions (Pavia, Italy, and Ticino, Switzerland) were retrieved and analyzed to evaluate the analysis time and post-shock time. Results Manikin based study . For shockable rhythms, none of the tested AEDs was able to complete the analysis and to charge the capacitors in less than ten seconds. The mean analysis time was 9.7 ± 1.5 s; the mean charging time was 6.9 ± 3.8 s; the mean post-shock pause was 6.7 ± 2.4 s. For non-shockable rhythms, the mean analysis time was (10.3 ± 2 s) and the mean post-analysis time was 6.2 ± 2.2 s. Clinical use. A total of 154 AED records [Emergency Medical Service (EMS) rescuers: 104 records; lay rescuers: 50 records] were analyzed. The post-shock pauses were significantly shorter than the post-analysis pauses [3.1 s (95%CI 2.6–3.7) vs 5.4 s (95%CI 5–5.7) p < 0.001] and EMS rescuers were faster in resuming CPR as compared to lay rescuers [5.3 s (95%CI 5–5.7) vs 8.6 s (95%CI 7.3–10) p < 0.001]. EMS rescuers’ post-shock and post-analysis pauses were considerably shorter than the ones suggested by AEDs [2.8 s (95%CI 2.4–3.3) vs 6.6 s (95%CI 6.2–6.9) p < 0.001, and 5.6 s (95%CI 5.4–5.9) vs 6.6 s (95%CI 6.5–6.8) p < 0.001, respectively]. On the contrary lay rescuers’ post-shock and post-analysis pauses were in line with the pauses suggested by the AED [7.3 s (95%CI 5–9.6) vs 6.3 s (95%CI 2.5–10.1) p = 0.62, and 8.9 s (95%CI 7.3–10.5) vs 7.6 s (95%CI 6.8–8.4) p = 0.14 respectively]. Conclusions AEDs have different performances that may negatively affect the quality of CPR mostly for those rescuers who follow AED vocal instructions. Both technological improvements and better lay rescuer training might be needed.