01-Jul-2022
3-minute read
Sudden cardiac arrest (SCA) affects more than 347,000 adults and 7,000 children in the United States each year.1 Whenever SCA strikes, early defibrillation with an automated external defibrillator (AED) like the LIFEPAK CR2 AED is essential to treating fatal ventricular fibrillation/pulseless ventricular tachycardia.
However, it is also critical to provide as much continuous CPR as possible throughout a resuscitation for the victim’s best chance of survival. In the 2020 American Heart Association (AHA) Guidelines for cardiopulmonary and emergency cardiovascular care, the importance of CPR during SCA is more direct:1
CPR is the single most important intervention for a patient in cardiac arrest,
and chest compressions should be provided promptly.
cprINSIGHT analysis technology
With the introduction of Stryker’s exclusive cprINSIGHT analysis technology in the LIFEPAK CR2 AED, pauses for ECG analysis and device charging are reduced or eliminated, allowing more time to deliver chest compressions and increase chest compression fraction (CCF).
- The initial rhythm analysis is conducted using the Shock Advisory System (SAS), which is available on Stryker’s LIFEPAK AEDs. This analysis requires rescuers to stop chest compressions to quickly determine if the patient is in a shockable rhythm. Early defibrillation for shockable rhythms drastically increases survival rates.1, 10, 11
- During subsequent analyses, cprINSIGHT analysis technology processes the patient’s ECG during chest compressions at the end of a two-minute cycle of CPR to classify the rhythm as:
1. Shockable (S): When the rhythm is classified S, the necessary pause time is shortened to only the time needed for the rescuer to stand clear and deliver the shock. Hands-off time for ECG analysis and charging the AED are eliminated.
2. Non-shockable (NS): When the rhythm is classified NS, the pause for analysis can be eliminated altogether, allowing for continuous CPR.
3. No decision (ND): Occasionally, cprINSIGHT analysis technology will reach ND, which means that the rhythm analysis during ongoing chest compressions is inconclusive. The device will prompt the rescuer to stop chest compressions to allow for an analysis using SAS. This is a safety feature designed to provide an additional analysis in these infrequent situations
Minimizing compression pauses
Resuscitation efforts present many challenges to pre-hospital and hospital healthcare providers. To address shortcomings and improve resuscitation efforts, organizations like the AHA and European Resuscitation Council (ERC) review the latest science on resuscitation and provide regular updates to lay rescuers and healthcare providers.
The AHA and ERC Guidelines for high-quality CPR stress the importance of minimizing pauses in chest compressions. They also recommend CCF be as high as possible, with a target of at least 60 percent (Class IIb):1,2
- Data demonstrated the longest compression pause, for any reason, was associated with decreased survival3
- Studies also show that higher compression fractions (hands-on compression time) and shorter pre/post-shock pauses are associated with increases in rates of return of spontaneous circulation (ROSC) and survival4,5,6,7
- Compressions during defibrillator charging may shorten shock pause duration and improve chest compression fraction in shockable out-of-hospital cardiac arrest (OHCA).8
Rhythm accuracy
Rhythm detection used in standard AEDs can be negatively impacted by patient movement during AED rhythm analysis. This can lead to inappropriate shock delivery or the failure to deliver shock that was advised.
Approximately 25 percent of errors can be caused by movement of the patient during AED rhythm analysis, mainly due to continuing chest compressions despite AED prompts to stop compressions.9
A study published in January 2021 in Resuscitation compared Amsterdam first responders’ use of the LIFEPAK 1000 AED vs. the LIFEPAK CR2 with cprINSIGHT analysis technology.12 Algorithm accuracy and CPR performance using both devices was reported.
- Accuracy: cprINSIGHT analysis technology reached a treatment decision (S or NS) during chest compressions 70 percent of the time and correctly identified shockable rhythms during chest compressions with 95.5 percent sensitivity and non-shockable rhythms with 98.2 percent specificity.
- Improvements in CPR performance: Pre-shock pauses were drastically reduced to an average of eight seconds vs. an average of 22 seconds with the conventional AED. CCF with cprINSIGHT analysis technology was 86 percent vs. 80 percent in the conventional AED group.
cprINSIGHT analysis technology was designed to reduce pauses and increase CCF during the treatment of SCA patients with the LIFEPAK CR2 AED. The algorithm is safe and effective for use on adults and children.
The LIFEPAK CR2 is also compatible with the LUCAS chest compression system and CODE-STAT data review software for continued resuscitation performance review and enhancement.
Together, we save lives
Connect with a representative to learn more about cprINSIGHT analysis technology.
1. Panchal A, Bartos J, Cabañas J, et 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 3: Adult basic and advanced life support. Circulation. 2020;142(suppl 2):S366-S468.
2. Soar J, Böttiger B, Carli P, et al., European Resuscitation Council Guidelines 2021: Adult advanced life support, Resuscitation 2021, https://doi.org/10.1016/j.resuscitation.2021.02.010.
3. Brouwer T, Walker R, Chapman F, et Association between chest compression interruptions and clinical outcomes of ventricular fibrillation out-of-hospital cardiac arrest. Circulation. 2015;132(11):1030-1037.
4. Cheskes S, Schmicker R, Christenson J, et Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation. 2011;124:58–66.
5. Vaillancourt C, Everson-Stewart S, Christenson J, et The impact of increased chest compression fraction on return of spontaneous circulation for out-of- hospital cardiac arrest patients not in ventricular fibrillation. Resuscitation. 2011;82:1501–1507.
6. Sell R, Sarno R, Lawrence B, et Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC). Resuscitation. 2010;81:822–825.
8. Christenson J, Andrusiek D, Everson-Stewart S, et Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009;120:1241–1247.
9. Cheskes S, Common M, Byers P, et Compressions during defibrillator charging shortens shock pause duration and improves chest compression fraction during shockable out of hospital cardiac arrest. Resuscitation. 2014;85(8)1007-111.
10. Zijlstra JA, Bekkers LE, Hulleman M, et Automated external defibrillator and operator performance in out-of-hospital cardiac arrest. Resuscitation. 2017;118:140-146.
11. Larsen M, Eisenberg M, Cummins R, et al. Predicting survival from out-of-hospital cardiac arrest: A graphic model. Annals of Emergency Medicine.1993;22:1652–1658.
12. Swor R, Jackson R, Cynar M, et al. Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest. Annals of Emergency Medicine. 1995;25:780–784.
13. de Graaf C, Beesems S, Oud S, et al. Analyzing the heart rhythm during chest compressions: Performance and clinical value of a new algorithm. Resuscitation. 2021. https://doi.org/10.1016/j.resuscitation.2021.01.003.
3346916_A