Accuracy of Automated External Defibrillators During Ambulance Transport: Simulation Study

ABSTRACT

PURPOSE: Current resuscitation guideline recommends not using the automated external defibrillator (AED) in a running ambulance, because artifact arising from movement of the ambulance can interfere with rhythm analysis of AED and can simulate ventricular fibrillation (VF). This study was conducted to determine whether the AED can be operated correctly in a running ambulance. METHODS: Five AEDs were tested for their sensitivity, specificity, positive/negative predictive value, and accuracy. Each AED was connected to a manikin randomly simulating coarse and fine VF, asystole, and normal sinus rhythm, and each rhythm was analyzed 5 times by AEDs on the highway. Data about the shock recommendation given and delivery time interval from analysis to shock were collected. ECGs were also downloaded during the analysis time for a normal volunteer to search for baseline artifacts. RESULTS: All AEDs recommended shock delivery correctly for the simulated rhythms whether the ambulance was stopped (0 km/h) or running on unpaved road (20 km/h). The sensitivity, specificity, positive/negative predictive value, and accuracy of AEDs on the highway (100 km/h) were similar to those obtained in previous studies on AED performance in pre-hospital settings. The recorded ECG rhythm of a volunteer in a running car showed no baseline artifacts. CONCLUSION: All AEDs recommended shock delivery correctly in a running ambulance. Therefore, the current recommendation of not using the AED on a running ambulance should be reconsidered.