A high-temporal resolution algorithm to discriminate shockable from nonshockable rhythms in adults and children

• Published in: Resuscitation Vol. 83; no. 9; pp. 1090 - 1097
• Main Authors: Irusta, Unai, Ruiz, Jesús, Aramendi, Elisabete, Ruiz de Gauna, Sofía, Ayala, Unai, Alonso, Erik
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-09-2012
• Subjects: Adult; Algorithms; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - therapy; Automated external defibrillator (AED); Cardiac arrest; Child; Child, Preschool; Defibrillation; Defibrillators; Electric Countershock; Emergency; Humans; Infant; Paediatric resuscitation; Ventricular arrhythmias; Ventricular arrhythmias; Automated external defibrillator (AED); Paediatric resuscitation; Defibrillation; Cardiac arrest
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2012.01.032

Abstract Aim To design the core algorithm of a high-temporal resolution rhythm analysis algorithm for automated external defibrillators (AEDs) valid for adults and children. Records from adult and paediatric patients were used all together to optimize and test the performance of the algorithm. Methods A total of 574 shockable and 1126 nonshockable records from 1379 adult patients, and 57 shockable and 503 nonshockable records from 377 children aged between 1 and 8 years were used. The records were split into two groups for development and testing. The core algorithm analyses ECG segments of 3.2 s duration and classifies the segments as nonshockable or likely shockable combining a time, slope and frequency domain analysis to detect normally conducted QRS complexes. Results The algorithm correctly identified 98% of nonshockable segments, 97.5% in adults and 98.4% in children, and identified 99.5% of shockable segments as likely shockable, 100% in adults and 96% in children. When likely shockable segments were further analysed in terms of regularity, spectral content and heart rate to form a complete rhythm analysis algorithm the overall specificity increased to 99.6% and the sensitivity was 99.1%. Conclusion Paediatric and adult rhythms can be accurately diagnosed using 3.2 s ECG segments. A single algorithm safe for children and adults can simplify AED use, and its high temporal resolution shortens pre-shock pauses which may contribute to improve resuscitation outcome.