Abstract 21: Automated External Cardioversion Defibrillation Monitoring in Telemetry Patients
Background: Sudden cardiac death causes 300,000 deaths each year. The initial rhythm of approximately 25% of in-hospital CPR events is pulseless ventricular tachycardia/ventricular fibrillation (VT/VF). Early defibrillation is an independent predictor of survival in CPR events caused by VT/VF. The automated external cardioverter defibrillator (AECD) is a device attached by pads to the chest wall that monitors, detects, and within seconds, automatically delivers electric countershock to a shockable rhythm.
Study Objectives: • To evaluate safety of AECD monitoring in hospitalized patients. • To evaluate whether AECDs provide earlier defibrillation than hospital code teams.
Methods: Using the PowerHeart CRM AECD monitor we designed a prospective trial randomizing patients to standard CPR (code team) or standard CPR plus AECD monitoring. The AECD is programmed to deliver a 150 Joule biphasic shock to patients in sustained VT/VF. Data is collected using the Utstein criteria for cardiac arrest. The primary endpoint is time-to-defibrillation; secondary outcomes include neurological status and survival to discharge, with 3-year follow-up.
Results: To date, 130 patients have been enrolled into the trial; one patient experienced sustained VT, which was successfully defibrillated (13 seconds after meeting programmed criteria) by the AECD. The patient survived the event without neurological complications. No events have occurred in the control arm of the trial. During the same time period, mean time to shock for VT/VF cardiac arrest occurring outside the telemetry ward was 230 ± 50 seconds. A total of 2,311 hours of telemetry data has been analyzed in the AECD arm. The AECD has monitored ambulatory telemetry patients in sinus rhythm, sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, with premature ventricular complexes and non-sustained VT without delivery of inappropriate shocks.
Conclusions: Our initial experience suggests that AECD technology is safe, and has the potential to reduce time to defibrillation in cardiac arrest. Additional data is needed to confirm safety of the AECD technology in other hospital settings and to assess its impact on short- and long-term outcomes in patients with in-hospital cardiac arrest.