TY - JOUR
T1 - Sensitivity and specificity of an automated external defibrillator algorithm designed for pediatric patients
AU - Atkins, Dianne L.
AU - Scott, William A.
AU - Blaufox, Andrew D.
AU - Law, Ian H.
AU - Dick, Macdonald
AU - Geheb, Frederick
AU - Sobh, Jamil
AU - Brewer, James E.
N1 - Funding Information:
This work was supported by ZOLL Medical Corporation, which provided salary support (DLA) and assistance and re-imbursement for acquisition of the EKG tracings to the other investigators.
Funding Information:
Dr. Dianne Atkins—current research support: ZOLL Medical Corporation (support for the work reported in this manuscript); previous (within last 5 years): Phillips Medical Systems Inc., research support, consulting fees, Medtronic Inc., consulting fees. Dr. William Scott—research support: ZOLL Medical Corporation (support for the work reported in this manuscript). Dr. Andrew Blaufox—research support: ZOLL Medical Corporation (support for the work reported in this manuscript). Dr. Ian Law—current research support: ZOLL Medical Corporation: educational grants: Boston Scientific Inc., Medtronic Inc.: previous proctoring support and speaker fees: Medtronic Inc. Dr. Macdonald Dick—research support: ZOLL Medical Corporation (Support for the work reported in this manuscript). Dr. Frederick Geheb—employee ZOLL Medical Corporation. Jamil Sobh—employee ZOLL Medical Corporation. James E. Brewer—employee ZOLL Medical Corporation.
PY - 2008/2
Y1 - 2008/2
N2 - Objective: Electrocardiographic (ECG) rhythm analysis algorithms for cardiac rhythm analysis in automated external defibrillators (AEDs) have been tested against pediatric patient rhythms (patients ≤8 years old) using adult ECG algorithm criteria. However these adult algorithms may fail to detect non-shockable pediatric tachycardias because they do not account for the difference in the rates of normal sinus rhythm and typical tachyarrhythmias in childhood. Methods: This study was designed to define shockable and non-shockable rhythm detection criteria specific to pediatric patients to create a pediatric rhythm database of annotated rhythms, to develop a pediatric-based AED rhythm analysis algorithm, and to test the algorithm's accuracy. Pediatric rhythm detection criteria were defined for coarse ventricular fibrillation, rapid ventricular tachycardia, and non-shockable rhythms, including pediatric supraventricular tachycardia. Pediatric rhythms were collected as sustained, classifiable, rhythms ≥9 s in length, and were annotated by pediatric electrophysiologists as clinically shockable or non-shockable based on pediatric criteria. Rhythms were placed into a pediatric rhythm database; each rhythm was converted to digitally accessible, public-domain, MIT rhythm data format. The database was used to evaluate a pediatric-based AED rhythm analysis algorithm. Results: Electrocardiographic rhythms from 198 children were recorded. There were 120 shockable rhythms from 49 patients (sensitivity; coarse ventricular fibrillation: 42 rhythms, 100%; rapid ventricular tachycardia: 78 rhythms, 94%), for combined sensitivity of 96.0% (115/120). There were 585 non-shockable rhythms from 155 patients (specificity normal sinus: 208 rhythms, 100%; asystole: 29 rhythms, 100%; supraventricular tachycardia: 161 rhythms, 99%; other arrhythmias: 187 rhythms, 100%), for combined specificity of 99.7% (583/585). Overall accuracy for shockable and non-shockable rhythms was 99.0% (702/709). Conclusions: New pediatric rhythm detection criteria were defined and analysis based on these criteria demonstrated both high sensitivity (coarse ventricular fibrillation, rapid ventricular tachycardia) and high specificity (non-shockable rhythms, including supraventricular tachycardia). A pediatric-based AED can detect shockable rhythms correctly, making it safe and exceptionally effective for children.
AB - Objective: Electrocardiographic (ECG) rhythm analysis algorithms for cardiac rhythm analysis in automated external defibrillators (AEDs) have been tested against pediatric patient rhythms (patients ≤8 years old) using adult ECG algorithm criteria. However these adult algorithms may fail to detect non-shockable pediatric tachycardias because they do not account for the difference in the rates of normal sinus rhythm and typical tachyarrhythmias in childhood. Methods: This study was designed to define shockable and non-shockable rhythm detection criteria specific to pediatric patients to create a pediatric rhythm database of annotated rhythms, to develop a pediatric-based AED rhythm analysis algorithm, and to test the algorithm's accuracy. Pediatric rhythm detection criteria were defined for coarse ventricular fibrillation, rapid ventricular tachycardia, and non-shockable rhythms, including pediatric supraventricular tachycardia. Pediatric rhythms were collected as sustained, classifiable, rhythms ≥9 s in length, and were annotated by pediatric electrophysiologists as clinically shockable or non-shockable based on pediatric criteria. Rhythms were placed into a pediatric rhythm database; each rhythm was converted to digitally accessible, public-domain, MIT rhythm data format. The database was used to evaluate a pediatric-based AED rhythm analysis algorithm. Results: Electrocardiographic rhythms from 198 children were recorded. There were 120 shockable rhythms from 49 patients (sensitivity; coarse ventricular fibrillation: 42 rhythms, 100%; rapid ventricular tachycardia: 78 rhythms, 94%), for combined sensitivity of 96.0% (115/120). There were 585 non-shockable rhythms from 155 patients (specificity normal sinus: 208 rhythms, 100%; asystole: 29 rhythms, 100%; supraventricular tachycardia: 161 rhythms, 99%; other arrhythmias: 187 rhythms, 100%), for combined specificity of 99.7% (583/585). Overall accuracy for shockable and non-shockable rhythms was 99.0% (702/709). Conclusions: New pediatric rhythm detection criteria were defined and analysis based on these criteria demonstrated both high sensitivity (coarse ventricular fibrillation, rapid ventricular tachycardia) and high specificity (non-shockable rhythms, including supraventricular tachycardia). A pediatric-based AED can detect shockable rhythms correctly, making it safe and exceptionally effective for children.
KW - Arrhythmias
KW - Automated external defibrillator (AED)
KW - Cardiac arrest
KW - Cardiac resuscitation
KW - Electric countershock/instrumentation
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U2 - 10.1016/j.resuscitation.2007.06.032
DO - 10.1016/j.resuscitation.2007.06.032
M3 - Article
C2 - 17765384
AN - SCOPUS:37849034409
SN - 0300-9572
VL - 76
SP - 168
EP - 174
JO - Resuscitation
JF - Resuscitation
IS - 2
ER -