The diagnostic accuracy of a shock advisory algorithm in automated external defibrillators in the presence of real-world artifacts.

Background: The current standards for shock advisory algorithms in AEDs require performance testing on artifact-free ECGs. However, AED analysis in the real world is more challenging due to potential artifacts from various sources (e.g.

A pilot evaluation of respiratory mechanics during prehospital manual ventilation.

Introduction: Respiratory mechanics, such as tidal volume (V) and inspiratory pressures, may affect outcome in hospitalized patients with respiratory failure. Little is known about respiratory mechanics in the prehospital setting.

Methods: In this prospective, pilot investigation of patients receiving prehospital advanced airway placement, paramedics applied a device to measure respiratory mechanics.

Improving response to out-of-hospital cardiac arrest: The verified responder program pilot.

Background: Survival following out-of-hospital cardiac arrest (OHCA) decreases as the interval from collapse to CPR and defibrillation increases. Innovative approaches are needed to reduce response intervals, especially for private locations.

Methods: We undertook the Verified Responder Program in 5 United States communities during 2018, whereby off-duty EMS professionals volunteered and were equipped with automated external defibrillators (AEDs).

Carotid Doppler blood flow measurement during cardiopulmonary resuscitation is feasible: A first in man study.

Objective: High quality chest compressions are the cornerstone of effective cardiopulmonary resuscitation (CPR). There is no available method of real time noninvasive hemodynamic measurement and feedback to inform rescuers of the efficacy of compressions. Ultrasound-based measures of blood flow may provide immediate, noninvasive hemodynamic information.

Waveform analysis-guided treatment versus a standard shock-first protocol for the treatment of out-of-hospital cardiac arrest presenting in ventricular fibrillation: results of an international randomized, controlled trial.

Background: Ventricular fibrillation (VF) waveform properties have been shown to predict defibrillation success and outcomes among patients treated with immediate defibrillation. We postulated that a waveform analysis algorithm could be used to identify VF unlikely to respond to immediate defibrillation, allowing selective initial treatment with cardiopulmonary resuscitation in an effort to improve overall survival.

Methods And Results: In a multicenter, double-blind, randomized study, out-of-hospital cardiac arrest patients in 2 urban emergency medical services systems were treated with automated external defibrillators using either a VF waveform analysis algorithm or the standard shock-first protocol.

Impacting sudden cardiac arrest in the home: a safety and effectiveness study of privately-owned AEDs.

Background: Sudden cardiac arrest (SCA) remains a major public health problem. The majority of SCA events occur in the home; however, scant data has been published regarding the effectiveness of privately owned AEDs.

Methods: The study, initiated in 2002 under prescription labeling, continued with over the counter availability in 2004 and was completed in 2009.

Comparison of current densities measured in a pig heart during states of ventricular fibrillation and post-mortem for different defibrillation electrode positions.

Current density imaging (CDI) is an MRI technique used to quantitatively measure current density vectors in biological tissue. A fast CDI sequence was developed that can image the whole body of a 4 kg pig in about 15 minutes. A state of ventricular fibrillation (VF) can be sustained for nearly 30 minutes allowing two complete CDI scans of the same subject.

The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation.

Background: We address the quality of chest compressions and the impact on initial defibrillation or initial chest compressions after sudden death.

Methods: Ventricular fibrillation was induced by occlusion of the left anterior descending coronary artery in 24 domestic pigs with a mean (+/- SD) weight of 40 +/- 2 kg. Cardiac arrest was left untreated for 5 min.

Outcome prediction for guidance of initial resuscitation protocol: Shock first or CPR first.

Background: Ventricular fibrillation (VF) is treated optimally with a defibrillation shock shortly after patient collapse, but may benefit from initial cardiopulmonary resuscitation (CPR) if the shock is delayed. An objective measure of potential responsiveness to defibrillation could help decide optimal initial therapy.

Methods And Results: a new electrocardiogram (ECG) analysis algorithm was compared with response interval (call-to-shock) for prediction of patient outcome in a population of 87 VF patients in the Rochester, Minnesota area.

Attenuated pediatric electrode pads for automated external defibrillator use in children.

Objective: This post-market, observational study is intended to evaluate reported uses of pediatric pads that reduce the energy delivered by some adult automated external defibrillators (AEDs) so that they may be used with pediatric patients.

Methods: Users of the pediatric pads were asked to report any use of the pads, even if no shock was delivered and to provide detailed information about the event, caregiver and the patient.

Results: Reports of the use of pediatric pads have been received and confirmed for 27 patients, age range 0 days to 23 years, median 2 years.

Transthoracic impedance does not affect defibrillation, resuscitation or survival in patients with out-of-hospital cardiac arrest treated with a non-escalating biphasic waveform defibrillator.

Objective: This is a study of the influence of transthoracic impedance (TTI) on defibrillation, resuscitation and survival in patients with out-of-hospital cardiac arrest (OHCA), treated with a non-escalating impedance-compensating 150 J biphasic waveform defibrillator.

Methods: Cardiac arrest data from two EMS systems were analyzed retrospectively. All witnessed arrests from patients who presented with a shockable rhythm and were treated initially by BLS personnel were included (n = 102).

Body weight does not affect defibrillation, resuscitation, or survival in patients with out-of-hospital cardiac arrest treated with a nonescalating biphasic waveform defibrillator.

Background: This is a study of the influence of body weight on defibrillation, resuscitation, and survival in patients with out-of-hospital cardiac arrest treated with a nonescalating impedance-compensating 150-J biphasic waveform defibrillator.

Methods: Cardiac arrest data from Rochester, MN, emergency medical services over a 6-yr period was retrospectively analyzed. Patient weight data were available for 62 of the 68 patients who were treated initially by basic life support personnel and who presented with a shockable rhythm.

Automated external defibrillator use by untrained bystanders: can the public-use model work?

Objective: For automated external defibrillators (AEDs) to be practical for broad public use, responders must be able to use them safely and effectively. This study's objective was to determine whether untrained laypersons could accurately follow the visual and voice prompt instructions of an AED.

Methods: Each of four different AED models (AED1, AED2, AED3, and AED4) was randomly assigned to a different group of 16 untrained volunteers in a simulated cardiac arrest.

AED use in businesses, public facilities and homes by minimally trained first responders.

Background: Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community to treat sudden cardiac arrest (SCA). We sought to study the use of AEDs in the home, businesses and other public settings by minimally trained first responders. The frequency of AED use, type of training offered to first responders, and outcomes of AED use were investigated.

Measurement of thoracic current flow in pigs for the study of defibrillation and cardioversion.

Although defibrillation has been in clinical use for more than 50 years, the complete current flow distribution inside the body during a defibrillation procedure has never been directly measured. This is due to the lack of appropriate imaging technology to noninvasively monitor the current flow inside the body. The current density imaging (CDI) technique, using a magnetic resonance (MR) imager, provides a new approach to this problem [Scott et al.